Thursday, Mordad 8^th

Panel 1: Mastering Cardiovascular Pharmacotherapy: Hypertension

Panel 2: Mastering Cardiovascular Pharmacotherapy: Heart Failure

Panel 3: Mastering Cardiovascular Pharmacotherapy: Antiplatelet Therapy

Panel 4: Mastering Cardiovascular Pharmacotherapy: Dyslipidemia

Friday, Mordad 9^th

Panel 1: Mastering Cardiovascular Pharmacotherapy: NOACs

Panel 2: Mastering Cardiovascular Pharmacotherapy: Diabetes

Panel 3: Mastering Cardiovascular Pharmacotherapy: Antianginal Therapy

Panel 4: Mastering Cardiovascular Pharmacotherapy: Obesity

Thursday, Mordad 8^th

Panel 1: Mastering Cardiovascular Pharmacotherapy: Hypertension

Clinical Approach to Hypertension Pharmacotherapy

• Apply an evidence-based approach to initiating antihypertensive pharmacotherapy by integrating office, home, and ambulatory blood pressure measurements, cardiovascular risk, and treatment thresholds.
• Select the optimal initial treatment strategy, including first-line drug classes, monotherapy versus combination therapy, and appropriate use of single-pill combinations.
• Implement effective treatment intensification strategies, including dose titration, timely addition of medications, and achievement of individualized blood pressure targets.
• Recognize apparent and true resistant hypertension, identify medication nonadherence as a potential cause of uncontrolled blood pressure, and determine when to escalate therapy and evaluate for secondary hypertension.
• Individualize antihypertensive therapy according to comorbidities, patient characteristics, and special clinical situations, including orthostatic hypotension.
• Develop appropriate follow-up and monitoring strategies to assess treatment response, optimize blood pressure control, and improve long-term outcomes.

Practical Optimization of Antihypertensive Pharmacotherapy

• Compare the advantages and limitations of first-line antihypertensive drug classes and select the most appropriate agent for individual patient profiles.
• Differentiate among individual agents within each drug class, considering efficacy, safety, pharmacokinetics, dosing, and patient-specific factors.
• Optimize initial dosing and dose titration, including appropriate use of monotherapy and single-pill combination therapy.
• Select the most appropriate drug combinations based on comorbidities, blood pressure response, tolerability, laboratory findings, and potential drug interactions.
• Monitor and manage medication-related adverse effects, and determine when to continue, adjust, switch, taper, or discontinue therapy.
• Optimize pharmacotherapy for resistant hypertension, including rational selection and sequencing of second- and third-line agents.
• Apply practical strategies to improve medication adherence, simplify treatment regimens, and optimize long-term blood pressure control.

Panel 2: Mastering Cardiovascular Pharmacotherapy: Heart Failure

Clinical Approach to Heart Failure Pharmacotherapy

• The contemporary treatment framework for HFrEF
• Prioritize the four pillars of therapy (Mortality & Morbidity benefits)
• Practical approach to early initiation and rapid optimization
• Patient phenotype to guide sequencing (Adapting initial treatment according to BP, HR, Cr, K level, Afib, and congestion)
• When to add non-foundational therapies (Identify appropriate candidates for ivabradine, hydralazine–isosorbide dinitrate, vericiguat, digoxin, iron therapy)

Practical Optimization of Heart Failure Pharmacotherapy

• Choose starting doses and titration targets (Review practical starting and target doses for sacubitril/valsartan, ACEi/ARB alternatives, beta-blockers, MRAs, and SGLT2 inhibitors)
• Build a safe titration plan (Design a 2–6 week optimization strategy based on blood pressure, heart rate, renal function, potassium, volume status, and patient symptoms)
• Monitor adverse effects systematically (Identify key monitoring requirements: creatinine/eGFR, potassium, blood pressure, heart rate, volume depletion, genital infections, hypoglycemia risk, and drug intolerance)
• Manage common medication problems (Provide practical solutions for hypotension, worsening renal function, hyperkalemia, bradycardia, diuretic overuse, polypharmacy, and non-adherence)
• Optimize diuretic strategy (how to avoid under- or over-diuresis)
• Improve implementation and adherence (Apply medication reconciliation, patient education, simplified regimens, cost-aware prescribing, follow-up labs, and team-based titration protocols)

Panel 3: Mastering Cardiovascular Pharmacotherapy: Antiplatelet Therapy

Clinical Approach to Antiplatelet Pharmacotherapy

• Apply evidence-based strategies for antiplatelet therapy in chronic coronary syndrome, including patients with prior PCI and those managed without coronary revascularization.
• Select the optimal antiplatelet strategy in acute coronary syndromes, including STEMI and NSTE-ACS, according to the clinical presentation and revascularization approach.
• Determine the appropriate duration of dual antiplatelet therapy (DAPT) and identify patients who may benefit from shortened or extended treatment.
• Choose the optimal long-term antiplatelet strategy after DAPT, including transition to single antiplatelet therapy when appropriate.
• Individualize antiplatelet therapy by balancing ischemic and bleeding risks using a patient-centered approach.
• Develop evidence-based antithrombotic strategies for patients with coronary artery disease who also require long-term oral anticoagulation.

Practical Optimization of Antiplatelet Pharmacotherapy

• Compare the pharmacology, efficacy, and safety of aspirin and available P2Y12 inhibitors, and select the most appropriate agent based on ischemic risk, bleeding risk, patient characteristics, and pharmacogenomic considerations.
• Optimize antiplatelet dosing by considering the indication, patient profile, comorbidities, laboratory findings, and concomitant therapies.
• Monitor and manage medication-related adverse effects, including bleeding and agent-specific toxicities (e.g., ticagrelor-associated dyspnea), and determine when to continue, adjust, switch, taper, or discontinue therapy.
• Apply pharmacokinetic and pharmacodynamic principles to optimize antiplatelet therapy, including perioperative interruption and resumption for elective procedures.
• Recognize and manage clinically important drug–drug interactions that may affect the efficacy or safety of antiplatelet therapy.
• Apply evidence-based strategies for switching between antiplatelet agents, including escalation, de-escalation, and transition between therapies in different clinical settings.
• Optimize gastrointestinal protection and other supportive measures, and tailor antiplatelet therapy for special populations, including patients with chronic kidney disease, advanced age, thrombocytopenia, low body weight, or prior gastrointestinal bleeding.

Panel 4: Mastering Cardiovascular Pharmacotherapy: Dyslipidemia

Clinical Approach to Dyslipidemia Therapy

• Cardiovascular risk classification in patients with dyslipidemia (Identify very-high-risk, high-risk, moderate-risk, and special-risk groups, including diabetes, CKD, familial hypercholesterolemia, and elevated Lp(a))
• Cardiovascular risk modifiers & Reclassification
• Explain the rationale for LDL-C lowering (Evidence-based & pathophysiologic)
• Define LDL-C treatment goals (New recommendations in new Guideline)

Choose initial pharmacotherapy based on risk (when to start high-intensity statin alone versus early combination therapy with ezetimibe or PCSK9-targeted therapy)

• Address dyslipidemia in metabolic disease (Individualize treatment in diabetes, obesity, metabolic syndrome, NAFLD/MASLD, and CKD)

Practical Optimization of Dyslipidemia Pharmacotherapy

• Compare lipid-lowering drug classes (expected LDL-C reduction, dosing, route, and major safety considerations for statins, ezetimibe, PCSK9 monoclonal antibodies, inclisiran, bempedoic acid, fibrates, and icosapent ethyl)
• Practical escalation strategy (treatment pathways for patients above LDL-C target despite maximally tolerated statin therapy)
• Manage statin-associated muscle symptoms (true statin intolerance or nocebo effect, drug interactions, hypothyroidism, vitamin D deficiency, and other mimics; rechallenge and alternate-dosing strategies)
• Monitor therapy safely (Identify baseline and follow-up monitoring for lipid panel, liver enzymes, CK when indicated, renal function for fibrates, uric acid with bempedoic acid, and drug-specific adverse effects)    

Friday, Mordad 9^th

Panel 1: Mastering Cardiovascular Pharmacotherapy: NOACs

Clinical Approach to Oral Anticoagulation in Atrial Fibrillation

• Apply evidence-based principles for initiating oral anticoagulation in patients with atrial fibrillation by balancing thromboembolic and bleeding risks.
• Select the most appropriate oral anticoagulation strategy, including when to choose a vitamin K antagonist versus a direct oral anticoagulant (DOAC).
• Individualize anticoagulation therapy according to patient characteristics, comorbidities, and special clinical situations.
• Develop optimal anticoagulation strategies for patients undergoing catheter ablation or left atrial appendage occlusion, including the appropriate duration of therapy before and after the procedure.
• Manage patients who experience ischemic stroke or systemic thromboembolism despite anticoagulation, including evaluation and subsequent treatment strategies.
• Develop evidence-based approaches for resuming anticoagulation after major bleeding when clinically appropriate.
• Establish appropriate long-term follow-up and reassessment strategies to optimize stroke prevention while minimizing bleeding risk.

Practical Optimization of Oral Anticoagulant Pharmacotherapy

• Compare the pharmacology, efficacy, and safety of available direct oral anticoagulants (DOACs) and select the most appropriate agent based on patient characteristics, comorbidities, renal and hepatic function, and concomitant medications.
• Optimize DOAC dosing according to indication, renal function, age, body weight, and other patient-specific factors, including differences between atrial fibrillation and venous thromboembolism indications.
• Apply pharmacokinetic and pharmacodynamic principles to optimize oral anticoagulant therapy and recognize clinically important differences among available agents.
• Monitor anticoagulant therapy by assessing renal function, hepatic function, laboratory parameters when appropriate, medication adherence, and treatment-related complications.
• Apply evidence-based strategies for perioperative interruption and resumption of oral anticoagulants for invasive procedures and surgery.
• Recognize and manage clinically important drug–drug interactions affecting oral anticoagulant therapy.
• Select and appropriately use reversal agents and other evidence-based strategies for managing anticoagulant-associated bleeding.
• Provide practical patient counseling to improve medication adherence, manage missed doses, and optimize the safe long-term use of oral anticoagulants.

Panel 2: Mastering Cardiovascular Pharmacotherapy: Diabetes

Clinical Approach to Diabetes Mellitus Pharmacotherapy

• Diabetes treatment for organ protection (why modern diabetes therapy should target ASCVD, heart failure, CKD, obesity, and hypoglycemia risk—not HbA1c alone)
• Individualize HbA1c targets (practical HbA1c targets according to age, frailty, ASCVD burden, CKD, heart failure, hypoglycemia risk, and life expectancy)
• Recognize high-risk diabetes phenotypes (diabetes with established ASCVD, post-ACS, heart failure, CKD, and obesity)
• Choice for therapy according to cardiovascular phenotype (when to prioritize GLP-1 receptor agonists for ASCVD/weight reduction and SGLT2 inhibitors for heart failure and CKD protection)
• Metformin Position in contemporary care (when metformin remains appropriate, when it should not delay SGLT2i/GLP-1RA use)
• Identify drugs that may worsen cardiovascular care (the limitations or cautions of sulfonylureas, insulin intensification, TZDs in heart failure, and selected DPP-4 inhibitors in HF-risk patients)

Practical Optimization of Diabetes Mellitus Pharmacotherapy

• Compare major glucose-lowering drug classes (Except INSULIN) (Summarize mechanism, expected HbA1c effect, weight effect, hypoglycemia risk, cardiovascular profile, and renal considerations)
• Practical dosing and titration (Review starting doses, dose escalation, renal dose limits, injection schedules, and follow-up timing for key agents)
• Monitor SGLT2 inhibitor safety (risk mitigation for genital infections, volume depletion, hypotension, ketoacidosis, perioperative interruption, acute illness, and diuretic adjustment)
• Monitor GLP-1RA and dual incretin therapy safety (Manage nausea, vomiting, constipation, gallbladder risk, pancreatitis concern, delayed gastric emptying, dehydration risk, and adherence to injection or oral regimens)
• Prevent hypoglycemia during therapy changes (Adjust insulin and sulfonylureas when SGLT2i, GLP-1RA, or weight-loss therapies are introduced)
• Drug interactions and implementation barriers (Manage polypharmacy, renal dysfunction, patient education, missed doses, and titration inertia)

Panel 3: Mastering Cardiovascular Pharmacotherapy: Antianginal Therapy

Clinical Approach to Anti-Anginal Pharmacotherapy

• Recognize the clinical spectrum of angina, including typical angina, anginal equivalents, and symptoms suggestive of myocardial ischemia.
• Apply an evidence-based approach to confirming myocardial ischemia and identifying patients who are appropriate candidates for anti-anginal pharmacotherapy.
• Determine when optimal medical therapy should be the primary treatment strategy and when coronary revascularization should be considered.
• Apply a stepwise approach to anti-anginal therapy, including treatment initiation, escalation, therapeutic goals, and assessment of treatment response.
• Objectively assess symptom burden, functional status, exercise tolerance, and quality of life to guide treatment decisions and follow-up.
• Recognize refractory angina and identify patients who may benefit from coronary revascularization or other non-pharmacologic treatment strategies.

Practical Optimization of Anti-Anginal Pharmacotherapy

• Compare the mechanisms of action, efficacy, and safety of available anti-anginal medications and select the most appropriate therapy based on patient characteristics, comorbidities, and hemodynamic profile.
• Optimize drug selection, initial dosing, dose titration, and treatment sequencing to achieve effective symptom control while minimizing adverse effects.
• Individualize anti-anginal pharmacotherapy according to heart rate, blood pressure, left ventricular function, renal and hepatic function, laboratory findings, concomitant medications, and associated comorbidities.
• Apply evidence-based principles for combination anti-anginal therapy, including rational add-on strategies and combinations to avoid.
• Monitor and manage medication-related adverse effects, contraindications, and clinically important drug–drug interactions.
• Integrate traditional and newer anti-anginal therapies into individualized treatment plans when appropriate.
• Develop practical strategies for follow-up, treatment optimization, medication adherence, and long-term symptom control.

Panel 4: Mastering Cardiovascular Pharmacotherapy: Obesity

Clinical Approach to Obesity Pharmacotherapy

• Obesity as a cardiovascular disease driver (how obesity contributes to ASCVD, HFpEF, hypertension, atrial fibrillation, diabetes, CKD, sleep apnea, and systemic inflammation)

Identify candidates for pharmacotherapy (BMI-based and comorbidity-based criteria for anti-obesity medication)

• Define realistic treatment goals (Distinguishing clinically meaningful weight loss thresholds: for metabolic improvement, for stronger cardiometabolic benefit, and for disease-modifying obesity care)
• Compare major anti-obesity drug classes (the clinical role of semaglutide, tirzepatide, liraglutide, orlistat, naltrexone/bupropion, and phentermine/topiramate from a cardiometabolic perspective.)
• Prioritize incretin-based therapy in high-risk cardiology patients (who may particularly benefit from GLP-1RA or dual GIP/GLP-1RA therapy, including those with ASCVD, diabetes, obesity-related HFpEF, hypertension, and metabolic syndrome.)
• Recognize when obesity pharmacotherapy is not enough (when to consider bariatric/metabolic surgery, sleep apnea management, structured lifestyle therapy, and referral to a multidisciplinary clinic)

Practical Optimization of Obesity Pharmacotherapy

• Compare dosing and titration schedules (Review practical initiation and dose-escalation schedules for semaglutide, tirzepatide, liraglutide, naltrexone/bupropion, phentermine/topiramate, and orlistat)
• Anticipate and manage adverse effects (Provide practical strategies for nausea, vomiting, constipation, diarrhea, reflux, dehydration, gallbladder symptoms, injection-site reactions, and treatment discontinuation)
• Identify contraindications and cautions (pregnancy, eating disorders, pancreatitis history, gallbladder disease, severe GI disease, MEN2/MTC warning, uncontrolled hypertension, CAD, and psychiatric risk)
• Monitor cardiometabolic response (Track weight, waist circumference, BP, heart rate, HbA1c, lipids, renal function, liver enzymes when relevant, symptoms of volume depletion, and nutritional adequacy)
• Adjust concurrent cardiovascular and diabetes medications (Prevent hypotension, hypoglycemia, dehydration, and over-treatment by reviewing antihypertensives, diuretics, insulin, sulfonylureas, and other glucose-lowering therapies)
• Improve adherence and persistence (Address injection technique, missed doses, dose escalation pause, patient expectations, weight regain after discontinuation, and long-term follow-up planning)