Question

1. In a person without Type 2 diabetes and with a 10-year ASCVD risk determined to be 15% with two other risk factors, what do the 2018 cholesterol guidelines suggest?
   1. The person may be withheld statin therapy because his 10-year risk is <20%
   2. The person should be considered for moderate intensity statin therapy
   3. The person is recommended for high intensity statin therapy
   4. None of the above
2. What is an example of secondary prevention?
   1. Reducing cholesterol levels in persons with a prior stroke
   2. Jump rope for heart health in school children
   3. Blood pressure control in persons with coronary calcium but no evidence of clinical events
   4. a and c
   5. All of the above

Answer 1

correct option is (c) the person is recommended for high statin therapy because in patients with severe primary hypercholeatrolemia (LDL-C greater or equal to 190mg/FL without calculating 10year ASCVD risk, begin high intensity statin therapy.  If the LDL-C level remains ≥100 mg/dl, adding ezetimibe is reasonable. If the LDL-C level on statin plus ezetimibe remains ≥100 mg/dl and the patient has multiple factors that increase subsequent risk of ASCVD events, a PCSK9 inhibitor may be considered, although the long-term safety (>3 years) is uncertain and economic value is uncertain at mid-2018 prices.

Rationale : Patients with HeFH are approved by the Food and Drug Administration (FDA) and most insurance carriers for PCSK9 inhibitor therapy regardless of presence of ASCVD because of very high risk. Those with HeFH and an LDL-C of 190 mg/dl have a 3-4-fold greater risk of CV events than others at the same LDL-C level and 20-fold greater risk than those with an LDL-C of 130 mg/dl. HeFH is more common than previously thought and needs to be considered in all persons with premature coronary disease and those with elevated LDL-C and family members with premature CAD or high LDL-C.

Correct option is (a) and (c) both because secondary prevention tries to intervene and hopefully put an end to the disease before it fully develops. It aims to identify a disease within a patient before the onset of symptoms and reduce the impact on the life of the patients. This section focuses on lifestyle interventions and medications.