Incorrect. While OGTT was previously advocated, it has limitations in practicality and reproducibility.

Correct. HbA1c is recommended as it is a strong predictor of vascular complications and has high reproducibility. Screening for diabetes is recommended in allindividuals with CVD, using fasting glucose and/or HbA1c (Class I, Level A).

Correct. Fasting glucose is also recommended for screening due to its simplicity and reproducibility. Screening for diabetes is recommended in allindividuals with CVD, using fasting glucose and/orHbA1c (Class I, Level A).

Incorrect. Postprandial glucose measurement is not specifically recommended for general screening in individuals with CVD.

Incorrect. Lansoprazole and pantoprazole do not have the same interaction issues with clopidogrel.

Correct. Omeprazole and esomeprazole are not recommended for gastric protection when clopidogrel is used due to potential drug interaction. (Class III, Level B).

Incorrect. Not all PPIs are contraindicated; only omeprazole and esomeprazole should be avoided.

Incorrect. Not all PPIs are safe to use with clopidogrel; omeprazole and esomeprazole should be avoided.

Incorrect. The HEART score is used for other cardiovascular conditions.

Correct. The WATCH-DM score includes risk factors like BMI, age, and hypertension to predict HF risk in T2DM patients. (Class I, Level B).

Incorrect. The CHA2DS2-VASc score is used to assess stroke risk in atrial fibrillation.

Incorrect. The ASCVD risk score is for atherosclerotic cardiovascular disease, not HF.

Correct. Diabetic patients are systematically screened for HF at each clinical encounter due to their increased risk. (Class I, Level C, ESC Guidelines 2023, Section 5.7).

Correct. In non-diabetic patients, HF screening is typically initiated only when symptoms or other risk factors are present.

Correct. Biomarkers like NT-proBNP and high-sensitivity troponin T are recommended to predict HF risk in diabetic patients. (Class I, Level B, ESC Guidelines 2023, Section 5.7).

Incorrect. Echocardiography is recommended for diabetic patients if HF symptoms or other risk factors are identified. (Class I, Level C, ESC Guidelines 2023, Section 5.7).

Correct. SGLT2 inhibitors are recommended for all patients with HFrEF and diabetes to reduce HF hospitalization and cardiovascular death. (Class I, Level A, ESC Guidelines 2023).

Correct. Beta-blockers are recommended for majority of patients. They should be avoided in patients with severe bradycardia, hypotension, or acute decompensation of HF with low cardiac output. (Class I, Level A).

Correct. Sacubitril/valsartan or ACE inhibitors are recommended for all patients with HFrEF and diabetes. (Class I, Level A, ESC Guidelines 2023).

MRAs are recommended for majority of patients, but they should be avoided in those with severe renal dysfunction (eGFR <30 mL/min) or hyperkalemia. (Class I, Level A).

Incorrect. LDL-C levels alone do not determine very high risk.

Correct. Patients with established ASCVD (atherosclerotic cardiovascular disease) are considered at very high risk according to SCORE2. (Class I, Level A).

Incorrect. This 10-year CVD risk threshold defines high risk but not very high risk.

Correct. Patients with diabetes and severe target organ damage, such as eGFR <45 mL/min/1.73 m², are at very high risk. (Class I, Level B).

Incorrect. Endurance exercise alone is not enough; resistance training is also recommended.

Correct. Structured exercise training in patients with T2DM and CVD is recommended to improve metabolic control, exercise capacity, and reduce CV events. (Class I, Level B).

Incorrect. Resistance exercises are recommended at least twice a week in addition to endurance training. (Class I, Level B).

Incorrect. Wearable activity trackers may be considered, but they are not recommended for all patients. (Class IIb, Level B).

Incorrect. NRT is one option, but other medications and counselling are also important.

Incorrect. Smoking cessation efforts should continue even after initial failures.

Correct. Combining counselling with medications like varenicline, bupropion, and NRT improves success rates. (Class IIa, Level B).

Correct. Both in-person and telephone counselling are effective for smoking cessation and should be considered.

Incorrect. While important, weight loss is recommended even in those with lower BMI.

Correct. GLP-1 RAs are recommended in patients with overweight or obesity to assist with weight loss. (Class IIa, Level B).

Incorrect. Medications like GLP-1 RAs play a key role alongside lifestyle changes.

Incorrect. Bariatric surgery is only suggested for patients with BMI ≥35 kg/m² who fail other interventions.

Incorrect. Clopidogrel alone is not sufficient for post-stenting.

Incorrect. Aspirin alone is insufficient for patients with coronary stenting.

Correct. DAPT, i.e. low-dose ASA with prasugrel or ticagrelor are preferred to DAPT with clopidogrel in patients with diabetes and ACS unless the patient is deemed at very high bleeding risk.

Incorrect. Warfarin is not used routinely for this purpose.

Incorrect. High-dose rivaroxaban is not recommended in this context.

Incorrect. Clopidogrel monotherapy may not provide sufficient long-term protection.

Correct. Very low-dose rivaroxaban plus low-dose aspirin is recommended for long-term prevention of vascular events. (Class IIa, Level B).

Incorrect. Warfarin is not the preferred option in this case.

Incorrect. Screening is recommended for all individuals with CVD, not just those with additional risk factors.

Correct. The guidelines recommend screening all individuals with CVD using fasting glucose and/or HbA1c. (Class I, Level A).

Incorrect. OGTT is no longer widely recommended due to its low reproducibility and practicality.

Incorrect. HbA1c is recommended as a reliable screening method for diabetes in patients with CVD.

Correct. A shorter duration of DAPT may be considered in patients with high risk of life-threatening bleeding. (Class I, Level A).

Incorrect. Shorter DAPT is not recommended for all patients.

Incorrect. Multivessel disease alone is not a reason to shorten DAPT duration.

Incorrect. Aspirin tolerance alone does not affect DAPT duration.

Incorrect. OAC should not always be continued post-CABG.

Correct. Long-term OAC is only indicated in patients with a high thromboembolic risk post-CABG. (Class I, Level C).

Correct. OAC should be continued in patients with AF or other OAC indications such as venous thromboembolism. (Class I, Level C).

Incorrect. OAC may be necessary in high-risk patients after CABG, so it is not "never".

Correct. Identifying and treating risk factors early is strongly recommended. (Class I, Level A).

Correct. Multidisciplinary behavioural approaches are recommended to manage diabetes effectively. (Class I, Level C).

Correct. Motivational interviewing is recommended to induce behavioural changes. (Class IIa, Level C).

Incorrect. Telehealth may be considered, but it is not the primary method for improving the risk profile. (Class IIb, Level B).

Correct. Weight loss through diet and physical exercise is recommended to improve metabolic control and reduce cardiovascular risk. (Class I, Level A).

Correct. GLP-1 RAs are considered for patients with obesity to aid weight loss. (Class IIa, Level B).

Incorrect. Bariatric surgery is reserved for BMI ≥35 kg/m².

Incorrect. Smoking cessation is important but not the only intervention.

Incorrect. Bariatric surgery is considered for patients with BMI ≥35 kg/m² after other strategies fail.

Correct. Bariatric surgery is recommended when structured efforts of lifestyle changes and weight-reducing medications do not result in maintained weight loss. (Class IIa, Level B).

Incorrect. Surgery is not necessary for all patients with obesity and T2DM.

Incorrect. Bariatric surgery is an option for certain high-risk patients.

Correct. Saxagliptin is associated with an increased risk of heart failure hospitalization and is not recommended for patients at risk of HF. (Class III, Level B).

Correct. Pioglitazone is associated with an increased risk of incident heart failure and is not recommended in patients at risk of HF. (Class III, Level A).

Incorrect. Metformin is not associated with an increased risk of heart failure hospitalization.

Incorrect. SGLT2 inhibitors are recommended for patients at risk of heart failure due to their cardiovascular benefits.

Incorrect. Systematic ECG screening is not recommended for patients <65 years.

Correct. Opportunistic screening by pulse taking or ECG is recommended in diabetic patients under 65, especially with other risk factors. (Class I, Level C).

Incorrect. Screening should occur even without symptoms in this population.

Incorrect. Screening in younger diabetic patients is important due to the higher AF frequency at a younger age.

Incorrect. Systematic ECG screening is not recommended for younger populations without symptoms.

Correct. Systematic ECG screening is recommended for patients aged ≥75 years or those at high risk of stroke. (Class IIa, Level B).

Incorrect. Heart failure is not the sole criterion for systematic ECG screening.

Incorrect. Systematic ECG screening is needed for high-risk populations, particularly the elderly.

Incorrect. Fibrates are not the first-line therapy for LDL-C lowering.

Correct. Intensive LDL-C lowering with statins or a statin/ezetimibe combination is recommended. (Class I, Level A).

Correct. Intensive LDL-C lowering with statins or a statin/ezetimibe combination is recommended. (Class I, Level A).

Incorrect. Niacin is not recommended for intensive LDL-C lowering.

Correct. Finerenone is recommended in addition to an ACE-I or ARB to reduce CV events and kidney failure. (Class I, Level A).

Incorrect. Spironolactone is not the recommended choice in this context.

Incorrect. Beta-blockers are used for blood pressure control, but not specifically recommended for reducing kidney failure risk.

Incorrect. Calcium channel blockers are not specifically recommended in this scenario.

Correct. SCORE2-Diabetes is unique because it combines both conventional and diabetes-specific risk factors, such as age at diagnosis and HbA1c.

Correct. It is specifically calibrated for European populations, accounting for country-level differences in cardiovascular risk.

Incorrect. CAC scoring is not included in the SCORE2-Diabetes algorithm due to insufficient evidence in diabetes risk reclassification.

Correct. SCORE2-Diabetes has been recalibrated to contemporary CVD rates and can be applied across various European regions with different CVD risks.

Incorrect. Aspirin is not contraindicated in CKD when ASCVD is present.

Correct. Low-dose aspirin (75–100 mg o.d.) is recommended in patients with CKD and ASCVD. (Class I, Level A).

Incorrect. Aspirin is recommended in all CKD patients with ASCVD, not just after stenting.

Incorrect. Aspirin is not restricted to end-stage CKD.

Correct. The combined use of an ARB with an ACE-I is not recommended due to an increased risk of adverse effects without proven benefits. (Class III, Level B).

Incorrect. Combining an ACE-I with a diuretic is common in CKD management.

Incorrect. Combining SGLT2 inhibitors with ACE-I is beneficial in reducing CKD progression and CVD risk.

Incorrect. Combining an ARB and beta-blocker is not contraindicated.

Incorrect. Increased insulin may cause hypoglycemia, which is harmful.

Correct. Avoiding hypoglycemic episodes is crucial in T1DM patients with CVD to prevent CV events. (Class I, Level C).

Incorrect. A fasting glucose target this low increases the risk of hypoglycemia.

Incorrect. Statins should also be considered in younger patients with additional risk factors.

Incorrect. Statins are not limited to patients with established CVD in this age group.

Incorrect. Statin therapy is considered in patients with specific risk factors.

Correct. Statins should be considered in patients under 40 with T1DM who have other CVD risk factors or microvascular damage. (Class IIa, Level B).

Incorrect. Statins are not indicated for those with low CVD risk in this context.

Correct. Statins should be considered in adults over 40 with T1DM to reduce CV risk, even without a history of CVD. (Class IIa, Level B).

Incorrect. Statins are also used for primary prevention.

Incorrect. Statins are not indicated in patients without risk factors under 40.

Correct. Statins should be considered in adults over 40 with T1DM to reduce CV risk, even without a history of CVD. (Class IIa, Level B).

Incorrect. The Framingham score is not recommended for patients with T1DM.

Correct. The Swedish/Scottish risk prediction model may be considered to estimate 10-year CVD risk in T1DM patients. (Class IIb, Level B).

Incorrect. QRISK2 is not the preferred tool for T1DM patients.

Incorrect. Risk assessment is important in T1DM to prevent CV events.

Incorrect. While lifestyle changes are important, surgical and medical treatments should not be excluded.

Incorrect. Medical treatment is important, but surgical or endovascular interventions may also be necessary, depending on the severity.

Correct. The same diagnostic and therapeutic strategies should be applied in both diabetic and non-diabetic patients. (Class I, Level C).

Incorrect. Conservative treatments are not necessarily required due to diabetes, as patients should receive the appropriate intervention based on disease severity.

Incorrect. NOACs are not recommended in patients with mechanical heart valves. (Class I, Level A).

Correct. NOACs are recommended for this patient with AF and diabetes, as there is no contraindication like mechanical valve prostheses or mitral stenosis. (Class I, Level A).

Incorrect. NOACs are not recommended in patients with moderate to severe mitral stenosis. (Class I, Level A).

Incorrect. NOACs are not indicated for patients with severe mitral stenosis, particularly post-surgery.

Correct.

Correct.

Correct.

Correct.

Correct.

Correct.

Correct.

Correct.

Correct. It includes factors like age at diagnosis and HbA1c.

Correct. It’s tailored for different regions in Europe.

Incorrect. CAC scores aren’t part of this model.

Correct. It’s designed to reflect current CVD rates across Europe.

Incorrect. Metformin is a Class IIa indication.

Correct. GLP-1 RAb is a Class I indication.

Incorrect. Metformin is a Class IIb indication.

Correct. SGLT2i is a Class I indication.

Incorrect. LDL-C target of <2.6 is indication in moderate risk patients.

Correct.

Incorrect. LDL-C target of <2.6 is indication in very high risk patients.

Incorrect. LDL-C target of <1.8 mmol/L and LDL-C reduction of at least 50% is recommended.

Incorrect. GLP-1 RAs have a neutral effect on the risk of HF hospitalization, and should be considered for glucose-lowering treatment in patients with T2DM at risk of or with HF. (IIa A)

Incorrect. DPP-4 inhibitors have a neutral effect on the risk of HF hospitalization, and should be considered for glucose-lowering treatment in patients with T2DM at risk of or with HF (IIa A)glucose-lowering treatment in patients with T2DM at risk of or with HF.

Incorrect. Metformin should be considered for glucose-lowering treatment in patients with T2DM and HF (IIa B)

Correct. I A indication.

Incorrect. <6.5% is too strict for most patients and may lead to hypoglycemia.

Correct. Tight glycaemic control with HbA1c <7% (<53 mmol/mol) is recommended to reduce microvascular complications, with adjustments based on individual risk factors. (Class I, Level A).

Incorrect. HbA1c <8% is too lenient to adequately control microvascular complications.

Incorrect. <6% is not recommended for most patients due to the increased risk of hypoglycemia.

Incorrect. CV safety is important, but agents with proven CV benefits are prioritized first.

Correct. Glucose-lowering agents with proven CV benefits should be prioritized, followed by those with proven CV safety. (Class I, Level C).

Incorrect. While metformin may be considered for additional glucose control, it is not the first priority for CV risk reduction.

Incorrect. GLP-1 RAs are safe and recommended even in patients with heart failure. GLP-1 RAs (lixisenatide, liraglutide, semaglutide, exenatide ER, dulaglutide, efpeglenatide) have a neutral effect on the risk of HF hospitalization, and should be considered for glucose-lowering treatment in patients with T2DM at risk of or with HF. (Class IIa, level A)

Incorrect. BP <120 mmHg is not recommended due to the risk of adverse effects. The BP goal is to target SBP to 130 mmHg and <130 mmHg if tolerated, but not <120 mmHg. (class I, level A)

Correct. The target SBP is 130 mmHg or lower, if well-tolerated, but not below 120 mmHg. (Class I, Level A).

Incorrect. The target is stricter, An on-treatment SBP target of <130 mmHg may beconsidered in patients with diabetes at particularlyhigh risk of a cerebrovascular event to further reducetheir risk of stroke (class IIb, level B)

Incorrect. BP targets are individualized but should not drop below 120 mmHg.

Incorrect. SBP <130 mmHg may not be well-tolerated in older adults due to the risk of hypotension. In older people (age>65 years), it is recommended to target SBP to 130–139 mmHg. (class I, level A)

Correct. The guidelines recommend an SBP target of 130–139 mmHg in older adults. (Class I, Level A).

Incorrect. Specific BP targets are provided for older adults to guide treatment.

Correct. BP targets are higher in older adults (130–139 mmHg) to prevent potential adverse effects like dizziness, falls, and orthostatic hypotension, which can be more frequent in this population with more aggressive BP lowering. (Class I, Level A).

Correct. PCSK9 inhibitors should be added if LDL-C is not controlled despite maximal statin and ezetimibe therapy. (Class I, Level A).

Correct. PCSK9 inhibitors are an option if statins are not tolerated. (Class IIa, Level B).

Incorrect. PCSK9 inhibitors are not first-line therapy; they are reserved for use when statins and ezetimibe fail to achieve LDL-C targets. They are typically recommended for high or very high cardiovascular risk patients, not moderate-risk patients. (Class I, Level A).

Incorrect. PCSK9 inhibitors are not recommended for moderate-risk patients because their use is reserved for patients at high or very high cardiovascular risk, where more aggressive LDL-C lowering is necessary.