Severe Hypercholesterolemia — USMLE Step 2 CK MCQ

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ModerateCardiologySevere HypercholesterolemiaUSMLE Step 2 CK

A 49-year-old has LDL-C 210 mg/dL, normal TG, no ASCVD. What is the recommended lipid-lowering therapy?

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Correct answer: D — High-intensity statin

For severe hypercholesterolemia (LDL-C ≥190 mg/dL), initiate high-intensity statin regardless of calculated risk. No therapy is unsafe. Ezetimibe alone is not first-line. Moderate-intensity is inadequate. PCSK9 monotherapy may be considered after maximized statin ± ezetimibe if LDL goals unmet.

Reference: AHA/ACC (2018): Guideline on the Management of Blood Cholesterol