CLS CLS Special Populations in Lipid Management 1 — Questions and Answers
Question 1: Which lipid-lowering medication is absolutely contraindicated in pregnancy due to teratogenicity?
- Statins (Correct answer)
- Bile acid sequestrants
- Ezetimibe at high doses
- Omega-3 fatty acids
Correct answer: Statins
Statins are absolutely contraindicated in pregnancy (Category X) because cholesterol is essential for fetal development and statins are teratogenic.
Question 2: In patients with chronic kidney disease (CKD) stages 3–5 not on dialysis, which lipid-lowering therapy is recommended by KDIGO guidelines?
- Statin or statin/ezetimibe combination (Correct answer)
- PCSK9 inhibitors as first-line
- Fibrates as first-line
- Niacin monotherapy
Correct answer: Statin or statin/ezetimibe combination
KDIGO guidelines recommend statin or statin/ezetimibe combination therapy for CKD stages 3–5 not on dialysis to reduce cardiovascular risk.
Question 3: What is the recommended approach to lipid-lowering therapy in patients on hemodialysis, based on evidence from the 4D and AURORA trials?
- Statins should not be initiated de novo in dialysis patients but may be continued if already prescribed (Correct answer)
- Statins are first-line therapy for all dialysis patients
- PCSK9 inhibitors replace statins in dialysis
- Fibrates are the preferred therapy
Correct answer: Statins should not be initiated de novo in dialysis patients but may be continued if already prescribed
The 4D and AURORA trials showed no cardiovascular benefit from initiating statins in dialysis patients, so current guidelines recommend not starting them de novo in this population.
Question 4: In patients with HIV on antiretroviral therapy, which statin is preferred due to minimal interaction with protease inhibitors?
- Pravastatin or rosuvastatin (Correct answer)
- Simvastatin or lovastatin
- Atorvastatin at high dose
- Fluvastatin only
Correct answer: Pravastatin or rosuvastatin
Pravastatin and rosuvastatin are preferred in HIV patients on protease inhibitors because they have minimal CYP3A4 metabolism, avoiding dangerous drug interactions.
Question 5: Which physiologic change during pregnancy normally causes triglyceride levels to increase?
- Increased estrogen stimulates hepatic VLDL production (Correct answer)
- Reduced renal triglyceride clearance
- Gestational diabetes in all pregnancies
- Decreased lipoprotein lipase activity from fetal demand
Correct answer: Increased estrogen stimulates hepatic VLDL production
Estrogen during pregnancy stimulates hepatic VLDL production, causing a physiologic rise in triglycerides that can unmask underlying hypertriglyceridemia disorders.
Question 6: In elderly patients (>75 years) without established cardiovascular disease, the decision to initiate statin therapy should prioritize which consideration?
- Shared decision-making weighing benefit, polypharmacy, functional status, and life expectancy (Correct answer)
- Aggressive LDL lowering to <55 mg/dL regardless of comorbidities
- Avoiding all statins due to myopathy risk
- Using only fibrates in this age group
Correct answer: Shared decision-making weighing benefit, polypharmacy, functional status, and life expectancy
In elderly patients for primary prevention, guidelines emphasize individualized shared decision-making given limited trial data, polypharmacy concerns, and varying life expectancy.
CLS CLS Special Populations in Lipid Management 1
Which lipid-lowering medication is absolutely contraindicated in pregnancy due to teratogenicity?