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Secondary prevention LDL management — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Secondary prevention LDL managementUSMLE Step 3

A 73-year-old man with diabetes and prior myocardial infarction has LDL cholesterol 86 mg/dL while taking high-intensity atorvastatin. He is adherent and has no adverse effects. He asks whether further lipid lowering is useful. Which of the following is the most likely diagnosis?

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Correct answer: C — Add ezetimibe after shared decision-making

Patients with established ASCVD at elevated residual LDL despite maximal statin therapy may benefit from adding ezetimibe before more intensive injectable options depending on risk and LDL threshold.

Reference: ACC/AHA cholesterol and chronic coronary disease guidance