Decision support only. Not medical advice. Consult a licensed clinician before initiating or changing therapy.

Patient 025

70y·female·white·ASCVD 5.6%

2 active reversal flags

  1. EndocrinologyHigh

    Hormone therapy for chronic disease prevention

    Why flagged

    Systemic HRT in an asymptomatic menopausal patient; chronic disease prevention use reversed by WHI 2002 and USPSTF 2022 (Grade D).

    1. Prior guidance2002

      Estrogen or combined estrogen/progestin hormone therapy widely prescribed for cardioprotection and chronic disease prevention (Pre-2002 consensus).

    2. WHI2002

      Combined CEE+MPA increased CHD (HR 1.18), stroke (HR 1.31), and invasive breast cancer (HR 1.26; 95% CI 1.00-1.59). Estrogen alone increased stroke risk without CHD benefit.

    3. Reversal2022

      Guidelines updated

    4. Current recommendation

      USPSTF (2022): Grade D recommendation against the use of systemic combined estrogen/progestin or estrogen alone for the primary prevention of chronic conditions.

  2. NephrologyModerate

    Renal artery stenting for atherosclerotic renal artery stenosis

    Why flagged

    Renal artery stent referral for ARAS patient; CORAL 2014 showed no benefit over medical therapy alone (35.1% vs. 35.8% events, p=NS).

    1. Prior guidance2014

      Routine angioplasty and stenting for significant atherosclerotic renal artery stenosis to treat refractory hypertension and preserve kidney function.

    2. CORAL2014

      Renal artery stenting added to medical therapy yielded no significant difference in CV/renal events (35.1% vs. 35.8%, HR 0.94; 95% CI 0.76-1.17) compared to medical therapy alone.

    3. Reversal2014

      Guidelines updated

    4. Current recommendation

      ACC/AHA Guidelines: Comprehensive medical therapy is the foundational treatment. Stenting provides no incremental benefit over medical therapy for most patients.