LDL-C Targets and Escalation — EECC MCQ

Correct answer: E — LDL-C of 1.6 is already at target for very high risk

Under current UK NICE guidance for secondary prevention of cardiovascular disease, the lipid target is LDL-C ≤2.0 mmol/L, or non-HDL-C ≤2.6 mmol/L. This patient has established CVD due to prior MI and is already on maximally tolerated high-intensity statin therapy plus ezetimibe. His LDL-C is 1.6 mmol/L, which is below the UK secondary-prevention LDL-C target, so no further LDL-lowering escalation is indicated on the basis of this result. The <1.4 mmol/L plus ≥50% reduction target is an ESC-style very-high-risk target and is not the current NICE target used for UK practice/exams. PCSK9 inhibitors or inclisiran should be considered only when the NICE lipid target is not met and the relevant NICE technology appraisal criteria are satisfied; rosuvastatin should not be increased beyond 40 mg. Therefore the correct answer is E: LDL-C of 1.6 mmol/L is already at target for very high risk/secondary prevention in UK practice.

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