Dyslipidaemia-Add-on Therapy — EECC MCQ

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ModerateCardiologyDyslipidaemia-Add-on TherapyEECC

A 63-year-old on rosuvastatin 20 mg has LDL 2.4 mmol/L with ASCVD (prior MI). Which nonstatin is recommended next to reach LDL <1.8 mmol/L?

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Correct answer: A — Add ezetimibe

This patient has established ASCVD after a prior myocardial infarction and remains above the stated LDL-C target despite high-intensity statin therapy with rosuvastatin 20 mg. In UK practice, the next non-statin LDL-lowering drug to add is ezetimibe, which inhibits intestinal cholesterol absorption and is recommended by NICE as an additional lipid-lowering option when the secondary-prevention lipid target is not met on the maximum tolerated statin; NICE also states that ezetimibe may be considered in addition to maximum tolerated statin therapy to reduce CVD risk further. Fibrates and omega-3 ethyl esters are not used to reach LDL-C targets, niacin is not recommended, and PCSK9 inhibitors are generally considered after optimisation with statin plus ezetimibe and according to NICE technology-appraisal criteria rather than as the first add-on here.

Reference: NICE Guideline NG238: Cardiovascular disease: risk assessment and reduction, including lipid modification; recommendations 1.7.1, 1.7.9 and 1.7.10, updated December 2023. https://www.nice.org.uk/guidance/ng238/chapter/recommendations