American Board of Internal Medicine (ABIM) Certification Practice Exam

For patients with metabolic syndrome and a 10-year cardiovascular risk of 10% or higher, which primary prevention therapy is recommended?

1. High-dose statins

2. Low-dose aspirin

3. Beta-blockers

4. ACE inhibitors

The correct answer is: Low-dose aspirin

In the context of metabolic syndrome and elevated cardiovascular risk, the recommendation for low-dose aspirin as a primary prevention therapy is guided by its role in reducing the incidence of cardiovascular events in individuals at higher risk. Aspirin acts as an antiplatelet agent, helping to prevent thrombus formation that can lead to heart attacks and strokes, which is particularly crucial for individuals with metabolic syndrome. These patients often have a greater likelihood of atherosclerosis and subsequent cardiovascular complications, making the use of low-dose aspirin a prudent approach in primary prevention strategies when their risk is 10% or higher. High-dose statins primarily focus on lipid management and have shown significant benefits in reducing overall cardiovascular risk, but they are typically indicated for patients with established cardiovascular diseases or those with very high LDL cholesterol levels, rather than as a primary preventive measure solely based on metabolic syndrome. Beta-blockers are mainly used in patients with existing cardiovascular conditions or for specific indications such as hypertension and heart failure rather than for primary prevention in those with metabolic syndrome. ACE inhibitors serve as an important therapy for hypertension, heart failure, and other specific cardiovascular conditions. Although they have protective cardiovascular effects, their use is generally more relevant in patients who already present with existing cardiovascular diseases or conditions such as heart failure