Non-Statin Lipid-Lowering Pharmacotherapy Flashcards

The REDUCE-IT trial demonstrated significant cardiovascular risk reduction using which specific omega-3 product at 4 g/day?

Answer: Icosapentaenoic acid (EPA only; Vascepa/icosapent ethyl)

REDUCE-IT showed that icosapentaenoic acid (EPA-only, Vascepa) at 4 g/day reduced major adverse cardiovascular events by 25% in statin-treated patients with elevated triglycerides and established cardiovascular disease or diabetes.

A concern with omega-3 products containing DHA (compared to EPA-only products) is that DHA may cause which adverse lipid effect?

Answer: Increased LDL-C

DHA-containing omega-3 formulations have been shown to increase LDL-C in some patients, a finding not observed with EPA-only icosapentaenoic acid, which may partly explain the different cardiovascular outcomes seen in REDUCE-IT versus the STRENGTH trial.

What is the primary lipid effect of prescription omega-3 fatty acids at 4 g/day?

Answer: Primarily reduce triglycerides by 25–50%

High-dose prescription omega-3 fatty acids (4 g/day) reduce triglycerides by 25–50% by suppressing hepatic VLDL-TG synthesis and enhancing lipoprotein lipase-mediated triglyceride clearance.

When ezetimibe is added to a maximally tolerated statin, what incremental LDL-C reduction is typically expected?

Answer: 15–20% additional reduction

Adding ezetimibe to statin therapy provides an additional LDL-C reduction of approximately 15–20% through complementary mechanisms: statins reduce hepatic cholesterol synthesis while ezetimibe reduces intestinal cholesterol absorption.

According to 2018 ACC/AHA guidelines, which non-statin agent is recommended as the preferred first add-on to statin therapy in very high-risk ASCVD patients requiring further LDL-C reduction?

Answer: Ezetimibe

The 2018 ACC/AHA Cholesterol Guideline recommends ezetimibe as the preferred first non-statin add-on for very high-risk ASCVD patients above LDL-C thresholds, given its cardiovascular outcomes data (IMPROVE-IT), tolerability, and cost-effectiveness.

Both icosapentaenoic acid (Vascepa) and omega-3-acid ethyl esters (Lovaza) are FDA-approved at 4 g/day for treating which condition?

Answer: Severe hypertriglyceridemia (≥500 mg/dL)

Both prescription omega-3 products are FDA-approved as adjuncts to diet for treatment of severe hypertriglyceridemia (≥500 mg/dL), while only Vascepa has the additional indication for cardiovascular risk reduction in statin-treated patients.

A patient with established ASCVD remains at LDL-C 110 mg/dL despite maximum-dose statin plus ezetimibe. According to ACC/AHA guidelines, what is the most appropriate next pharmacologic step?

Answer: Add a PCSK9 inhibitor

For very high-risk ASCVD patients above the LDL-C threshold (≥70 mg/dL) despite maximally tolerated statin and ezetimibe, the 2018 ACC/AHA guidelines recommend considering a PCSK9 inhibitor as the next add-on therapy given its proven cardiovascular outcomes benefit.