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LDL-C Target Secondary Prevention — EECC MCQ

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HardCoronary Artery DiseaseLDL-C Target Secondary PreventionEECC

A patient with established coronary disease starts atorvastatin 80 mg. Baseline total cholesterol is 6.2 mmol/L and HDL-C 1.1; at 3 months they are 4.4 and 1.0 mmol/L. Adherence is confirmed. What is the correct interpretation?

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Correct answer: B — Non-HDL fell only 33%; intensify secondary prevention

Baseline non-HDL cholesterol is 5.1 mmol/L and follow-up non-HDL is 3.4 mmol/L, a reduction of roughly 33%. NICE seeks more than a 40% reduction in non-HDL cholesterol for secondary prevention. After confirming adherence, timing, lifestyle and secondary causes, additional lipid-lowering treatment should be considered through the appropriate pathway. Total cholesterol below 5 mmol/L is not the treatment target, and the small HDL change is not a reason to reduce a tolerated high-intensity statin.

Reference: NICE NG238: cardiovascular risk assessment and lipid modification. https://www.nice.org.uk/guidance/ng238/chapter/recommendations