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Secondary cardiovascular prevention — RACGP Fellowship MCQ

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HardChronic disease managementSecondary cardiovascular preventionRACGP Fellowship

Two months after NSTEMI, a 61-year-old man has LDL-C 2.8 mmol/L while adherent to atorvastatin 40 mg daily. He reports no myalgia, liver tests are normal and no interacting medicine is present. What is the best next lipid-management step?

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Correct answer: B — Increase atorvastatin to 80 mg and recheck LDL-C promptly

Explanation lettering: C = shown as A · A = shown as C

B is correct. After ACS, LDL-C 2.8 mmol/L is markedly above the secondary-prevention target, so tolerated atorvastatin should be increased to 80 mg and ezetimibe added later if the target is not reached. A accepts substantial residual risk despite inadequate lipid lowering. C does not replace evidence-based LDL reduction after NSTEMI. D reverses the meaning of normal safety tests, which support continuation rather than cessation. E introduces dangerous therapeutic inertia during the highest-risk period. The immediate choice is high-intensity statin escalation; subsequent non-statin treatment depends on the achieved response and eligibility.

Reference: Heart Foundation: Australian clinical guideline for diagnosing and managing acute coronary syndromes 2025: https://www.heartfoundation.org.au/for-professionals/acs-guideline