skip to main content

Type 2 diabetes with CKD — ABIM Board MCQ

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

HardEndocrinology/MetabolismType 2 diabetes with CKDABIM Board

A 64-year-old with type 2 diabetes and prior myocardial infarction takes atorvastatin 80 mg daily. LDL cholesterol is 48 mg/dL, fasting triglycerides are 238 mg/dL on two measurements, A1C is 7.0%, and secondary causes of hypertriglyceridemia have been addressed. Which addition may further reduce cardiovascular events?

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

Reveal the answer and explanation

Correct answer: A — Add icosapent ethyl after discussing benefit and atrial-fibrillation risk

The best answer is “Add icosapent ethyl after discussing benefit and atrial-fibrillation risk”. In a statin-treated patient with established ASCVD, controlled LDL cholesterol and triglycerides between 150 and 499 mg/dL, icosapent ethyl can reduce residual cardiovascular risk. Benefits from the purified EPA formulation should not be extrapolated to generic fish-oil mixtures. Fibrates and niacin have not shown comparable event reduction in this setting, and further LDL lowering is not the principal residual abnormality.

Reference: ADA Standards of Care in Diabetes—2026: Cardiovascular Disease and Risk Management: https://diabetesjournals.org/care/article/49/Supplement_1/S216/163933/10-Cardiovascular-Disease-and-Risk-Management