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High-Intensity Statin Indication — RACP Adult Medicine MCQ

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EasyCardiologyHigh-Intensity Statin IndicationRACP Adult Medicine

A 55-year-old man with type 2 diabetes and a 10-year cardiovascular risk of 18% (high risk) has LDL-C 3.8 mmol/L despite lifestyle modification. He has no known CVD, no statin intolerance, and normal LFTs. What is the most appropriate lipid-lowering therapy?

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Correct answer: E — High-intensity statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg)

High cardiovascular risk (10-year risk >15% or diabetes with additional risk factors) with LDL-C above target (>1.8 mmol/L for high risk) requires high-intensity statin as first-line. NHFA 2024 targets: LDL-C <1.8 mmol/L for high-risk, <1.4 mmol/L for very high-risk (established CVD). If target not achieved on maximum tolerated statin, add ezetimibe. If still above target, consider PCSK9 inhibitor (PBS-listed for very high risk with LDL >2.6 on maximal oral therapy).

Reference: NHFA – 2024 – Lipid Management; ADS 2024