PCSK9 Inhibitor Indication — EECC MCQ

Instant feedback + full explanation. One question, done properly.

EasyHypertension & Preventive CardiologyPCSK9 Inhibitor IndicationEECC

A 58-year-old man with established atherosclerotic CVD (prior MI) has an LDL-C of 2.1 mmol/L on atorvastatin 80 mg and ezetimibe 10 mg. His target LDL-C is <1.4 mmol/L. What is the recommended next step according to ESC dyslipidaemia guidelines?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Add a PCSK9 inhibitor (evolocumab or alirocumab)

A prior MI is established atherosclerotic cardiovascular disease, placing him in the ESC/EAS very-high-risk category. His stated LDL-C goal is <1.4 mmol/L, but his LDL-C remains 2.1 mmol/L despite maximal high-intensity statin therapy with atorvastatin 80 mg plus ezetimibe 10 mg. The ESC/EAS stepwise approach is: maximally tolerated statin, then add ezetimibe, and if the LDL-C goal is still not achieved, add a PCSK9 inhibitor such as evolocumab or alirocumab. Fibrates are mainly for hypertriglyceridaemia, switching to rosuvastatin is unlikely to provide the required additional LDL-C reduction after atorvastatin 80 mg, and accepting the level is inappropriate because he remains above target.

Reference: 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk, European Heart Journal, 2020;41:111-188. https://academic.oup.com/eurheartj/article/41/1/111/5556353