Cardiovascular Health

Should adults take statins for primary cardiovascular prevention?

Meta-analyses of primary prevention trials show reduced major adverse cardiovascular events with statins in appropriately selected moderate-to-high-risk adults. Shared decision-making should weigh absolute risk reduction against side effects and patient preference.

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Should aspirin be used for primary cardiovascular prevention?

Current guidelines generally discourage routine aspirin for primary prevention in low-to-moderate-risk adults because bleeding harm offsets modest benefit. Select high-risk individuals may still be considered with shared decision-making.

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Do therapies that raise HDL reduce cardiovascular events?

Trials of niacin and CETP inhibitors raised HDL without consistent reduction in cardiovascular events when added to statins, challenging the hypothesis that raising HDL alone is protective.

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Does elevated lipoprotein(a) independently increase cardiovascular risk?

Mendelian randomization and epidemiologic data support Lp(a) as a causal cardiovascular risk factor. Specific Lp(a)-lowering therapies are emerging but routine treatment beyond standard risk factor control awaits outcome trial confirmation.

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Is ApoB more useful than LDL-C for cardiovascular risk prediction?

Prospective cohorts and meta-analyses suggest ApoB may capture atherogenic particle burden better than LDL-C alone, particularly when triglycerides are elevated or LDL particles are discordant with LDL-C.

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Should coronary artery calcium scoring guide statin decisions?

Coronary artery calcium can reclassify intermediate-risk patients and inform statin initiation when risk is uncertain. A score of zero may support deferring therapy in selected low-risk individuals with shared decision-making.

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Do omega-3 supplements prevent cardiovascular disease in the general population?

High-dose EPA (icosapent ethyl) reduced events in selected high-risk statin-treated patients in REDUCE-IT. General over-the-counter omega-3 supplements show inconsistent or null benefit in primary prevention populations.

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Does hormone replacement therapy reduce cardiovascular risk in early menopause?

The timing hypothesis suggests earlier initiation may differ from late initiation, where WHI showed harm for combined therapy. Current guidelines emphasize individualized risk assessment rather than routine cardioprotection.

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Is there a critical timing window for cardiovascular benefit from HRT?

The critical-window concept proposes that starting HRT closer to menopause may yield different cardiovascular effects than starting later. WHI subgroup analyses inform but do not prove this hypothesis for routine practice.

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