Refractory Dyslipidaemia — RACP Adult Medicine MCQ

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ModerateCardiologyRefractory DyslipidaemiaRACP Adult Medicine

A 72-year-old woman with a recent NSTEMI is found to have an LDL-C of 2.1 mmol/L despite atorvastatin 80 mg daily and ezetimibe 10 mg daily. According to the 2025 Australian ACS guideline, what additional therapy should be considered?

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Correct answer: E — PCSK9 inhibitor (evolocumab or alirocumab)

The 2025 ACS guideline recommends that if LDL-C remains above the target of <1.4 mmol/L despite maximal statin plus ezetimibe, a PCSK9 inhibitor should be considered. These agents reduce LDL-C by a further 50–60% and have demonstrated cardiovascular event reduction in the FOURIER and ODYSSEY OUTCOMES trials. PBS listing in Australia requires failure to reach target on maximal tolerated statin plus ezetimibe.

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