Primary Prevention Lipids — EECC MCQ
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Correct answer: B — Moderate-intensity statin after clinician-patient discussion
The best answer is B. For primary prevention, lipid-lowering should not be decided solely by a rigid risk cut-off. In UK practice, NICE uses QRISK3 rather than the US ASCVD calculator, but the exam principle is the same: a 10-year risk around 9% does not mandate no treatment. NICE recommends discussing the benefits, harms, comorbidities, patient preferences and risk uncertainty, and specifically says not to rule out statin treatment just because 10-year QRISK3 is below 10% if the person has an informed preference for treatment or risk may be underestimated. LDL 2.4 mmol/L is not an indication for PCSK9 inhibitor therapy and does not justify high-intensity statin therapy for everyone. Lifestyle advice remains important, but the recommended next step is shared decision-making about starting a standard primary-prevention statin regimen, corresponding here to a moderate-intensity statin after clinician-patient discussion.
Reference: NICE guideline NG238: Cardiovascular disease: risk assessment and reduction, including lipid modification. Recommendations on lipid-lowering treatment for primary prevention, including recommendations 1.6.7–1.6.8. Published 2023, updated 2025. https://www.nice.org.uk/guidance/ng238/chapter/recommendations