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Knee osteoarthritis with CKD and ulcer disease — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareKnee osteoarthritis with CKD and ulcer diseaseUSMLE Step 3

A 46-year-old with diabetes has fasting triglycerides of 1,180 mg/dL despite correction of secondary causes, atorvastatin 80 mg, prescription omega-3 therapy and a very-low-fat diet. A fibrate is now selected because triglycerides remain markedly elevated. Which modification best limits a fibrate-statin interaction while retaining both therapies?

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

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Correct answer: B — Continue atorvastatin and add fenofibrate

The best answer is “Continue atorvastatin and add fenofibrate”. ACC guidance advises fenofibrate rather than gemfibrozil when fibrate treatment is added to a statin because gemfibrozil produces a more important interaction and greater myopathy risk. The stem already establishes appropriate diet, secondary-cause management and prescription omega-3 therapy, so the tested discriminator is selection of the safer fibrate-statin pairing rather than whether either drug class can lower triglycerides.

Reference: ACC Expert Consensus Decision Pathway: Hypertriglyceridemia: https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2021/07/27/21/04/2021-ACC-ECDP-Hypertriglyceridemia