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Dyslipidaemia Management — RACP Adult Medicine MCQ

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ModerateCardiologyDyslipidaemia ManagementRACP Adult Medicine

A 68-year-old man with a history of ischaemic stroke 3 months ago is commenced on atorvastatin 80 mg. According to the 2025 Australian ACS guideline, if his LDL-C remains above target at 1.8 mmol/L despite maximum statin, what is the next appropriate lipid-lowering agent?

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Correct answer: C — Ezetimibe

The 2025 Australian ACS guideline recommends adding ezetimibe if LDL-C remains above target (<1.4 mmol/L) despite maximum tolerated statin. If LDL-C is still above target on statin plus ezetimibe, a PCSK9 inhibitor (evolocumab or alirocumab) should be considered. The PBS lists PCSK9 inhibitors for patients with familial hypercholesterolaemia or clinical ASCVD who remain above target on maximum therapy including ezetimibe.

Reference: NHF/CSANZ – 2025 – Australian ACS Guideline; PBS – 2025 – PCSK9 Inhibitor Listings