Quiz #3: AHA/ACC 2018 Lipid Guidelines

1. Which of the options above would be guideline-recommended care for a patient with primary hypercholesterolemia, with an LDL-C of 192 mg/dL?

Answer: C. Start high-intensity statin. For high-risk patients with severe primary hypercholesterolemia (LDL-C >190 mg/dL), the AHA/ACC guidelines recommend initiating a high-intensity statin without calculating the 10-year ASCVD risk or obtaining a CAC score. Ezetimibe should then be considered for treatment intensification followed by a PCSK9 inhibitor.
 

2. Which of the patients above clearly falls into a statin treatment benefit group?

Answer: B. 42-year-old woman with diabetes and LDL-C of 72 mg/dL. All patients with diabetes aged 40-75 with LDL ≥70 mg/dL have a class IA recommendation in the guidelines to initiate at least moderate intensity statin therapy. The man in option A warrants intensification of lifestyle therapy as the next step. The 80-year-old in option C falls outside the age range for the guideline statin benefit groups and of ASCVD.

Statin therapy benefit group? The 50-year-old woman with psoriasis (option D) and the 42-year-old woman in early menopause (option E) may benefit from a statin – but not until after a discussion of treatment options and consideration of CAC for refinement of risk assessment.

3. Which of the options above would be recommended as the first step for a 22-year-old overweight man presenting with LDL-C of 153 mg/dL?