CLS Non-Statin Lipid-Lowering Pharmacotherapy 3

Question 1

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

Accepted Answer

Icosapentaenoic acid (EPA only; Vascepa/icosapent ethyl)

Answer

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.

Question 2

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

Accepted Answer

Increased LDL-C

Answer

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.

Question 3

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

Accepted Answer

Primarily reduce triglycerides by 25–50%

Answer

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.

Question 4

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

Accepted Answer

15–20% additional reduction

Answer

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.

Question 5

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?

Accepted Answer

Ezetimibe

Answer

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.

(CLS) Clinical Lipid Specialist Certification Practice Test

(CLS) Clinical Lipid Specialist Certification Practice Test

CLS Non-Statin Lipid-Lowering Pharmacotherapy 3