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Severe primary hypercholesterolemia — USMLE Step 3 MCQ

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EasyAmbulatory Medicine / Primary CareSevere primary hypercholesterolemiaUSMLE Step 3

A 42-year-old man comes for a health maintenance visit. His father died suddenly at age 49. He has no symptoms. Blood pressure is 124/76 mm Hg. LDL cholesterol is 196 mg/dL on repeat testing, triglycerides are 120 mg/dL, and A1c is 5.4%. Which of the following is the most appropriate next step in management?

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Correct answer: C — Start high-intensity statin therapy

LDL cholesterol of 190 mg/dL or higher warrants high-intensity statin therapy regardless of calculated 10-year ASCVD risk. Family history suggests possible familial hypercholesterolemia.

Reference: ACC/AHA Cholesterol Guideline