Statin in Primary Prevention — EECC MCQ

Correct answer: D — At low-to-moderate CVD risk, lifestyle modification is first-line; a statin may be considered if LDL-C remains above 3.0 mmol/L despite lifestyle measures

This is an ESC-specific primary-prevention question. She is 52 years old with no established ASCVD, diabetes or familial hypercholesterolaemia, and a 10-year SCORE2 risk of 4%, which places her in the low-to-moderate risk category in the ESC prevention framework for this age group. ESC management is stepwise: optimise non-pharmacological measures first, including diet, physical activity, weight management and smoking avoidance/cessation. A statin is not mandatory simply because she is over 50, and lipid-lowering treatment is not reserved only for established CVD. However, because her LDL-C is 3.5 mmol/L, i.e. above the low-risk LDL-C threshold/goal of 3.0 mmol/L, pharmacological LDL-C lowering with a statin may be considered if LDL-C remains elevated despite lifestyle optimisation. PCSK9 inhibitors are not first-line primary-prevention treatment for this low-to-moderate-risk scenario.

Reference: European Society of Cardiology/European Atherosclerosis Society. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias; Recommendation Table 1: primary-prevention pharmacological LDL-C-lowering should be considered at low risk when LDL-C is ≥3.0 mmol/L despite optimisation of non-pharmacological measures. https://academic.oup.com/eurheartj/article/46/42/4359/8234482