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Secondary cardiovascular prevention — CCFP MCQ

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ModerateChronic disease managementSecondary cardiovascular preventionCCFP

A 63-year-old man with a previous myocardial infarction attends for lipid management review. He is not currently on any lipid-lowering medication. Laboratory results show: LDL-C 2.6 mmol/L, HDL-C 0.9 mmol/L, triglycerides 1.7 mmol/L. Liver enzymes are normal. Which is the most appropriate management?

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Correct answer: D — Start high-intensity statin therapy and reinforce lifestyle modifications

**Answer: A (Start high-intensity statin therapy and reinforce lifestyle modifications)** Post-myocardial infarction patients require intensive lipid management. High-intensity statin monotherapy is the guideline-recommended first-line intervention in Canadian and international secondary prevention guidelines. The patient's LDL-C of 2.6 mmol/L exceeds secondary prevention targets (typically <1.4–1.8 mmol/L) and requires pharmacological intervention. Normal hepatic function permits safe initiation. **Why distractors fail:** - **B (Fish oil):** No evidence base for first-line use post-MI; not recommended by CFPC or CCS. - **C (Defer 5 years):** Inappropriate delay in secondary prevention; high-risk patients require prompt intervention. - **D (Niacin):** Not first-line; evidence for benefit is limited; statins superior. - **E (Ezetimibe monotherapy):** Statin therapy must be maximized first (high intensity) before adding ezetimibe as adjunctive therapy per CFPC guidance.

Reference: College of Family Physicians of Canada. Lipid-lowering therapies for cardiovascular disease prevention and management in primary care. Can Fam Physician 2023;69(10):701. https://www.cfp.ca/content/69/10/701