AHA/ACC 2018 Guidelines on Treatment of Blood Cholesterol: Quiz #2

1. Which of the above would be the next appropriate therapeutic step for a patient aged 50 years who recently had a second heart attack, has hypertension, and is found to have a nonfasting LDL-C of 100 mg/dL on high-intensity statin therapy plus ezetimibe after >3 months of therapy?

Answer: D. Consider initiating a PCSK9i after a discussion with the patient. This very high-risk ASCVD patient warrants consideration of the tighter LDL-C control offered by a PCSK9i but only after a discussion that includes consideration of the potential benefit, safety, and cost of treatment.

Of note, given the patient’s premature coronary artery disease and the fact that the untreated LDL-C may have been >200 mg/dL, a diagnosis of familial hypercholesterolemia should be entertained.

2. Which one of the above is NOT considered considered a risk-enhancing factor under the 2018 AHA/ACC guidelines?

Answer: E. Periodontal disease is not considered a risk-enhancing factor by the 2018 guidelines.

3. What would be the next most appropriate step in management for a patient aged 60 years with LDL-C 90 mg/dL and an estimated 10-year ASCVD risk of 10%, in whom the decision about statin therapy is uncertain?