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Lipid Management — UKMLA MCQ

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HardCardiologyLipid ManagementUKMLAMRCGP AKTPARAPSA

For primary prevention, baseline total cholesterol is 6.5 mmol/L and HDL cholesterol 1.3 mmol/L. After atorvastatin 20 mg, total cholesterol is 4.8 mmol/L and HDL cholesterol 1.2 mmol/L. Adherence is confirmed and treatment is tolerated. Which interpretation is correct?

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Correct answer: C — The non-HDL reduction is about 31%, so consider dose intensification

Baseline non-HDL cholesterol is 6.5 minus 1.3, or 5.2 mmol/L. The repeat value is 4.8 minus 1.2, or 3.6 mmol/L. The reduction is therefore 1.6 divided by 5.2, approximately 31%, which is below the greater-than-40% reduction sought for primary prevention. After confirming adherence, timing and lifestyle measures, NICE advises considering an increased atorvastatin dose up to the maximum tolerated and appropriate dose. A small HDL change is not a reason to abandon effective risk reduction.

Reference: NICE NG238, assessing response to statin treatment. https://www.nice.org.uk/guidance/ng238/chapter/recommendations