CLS Therapeutic Lifestyle & Pharmacologic Interventions 2 — Questions and Answers
Question 1: A patient on high-intensity statin therapy has LDL-C still above goal. Which add-on therapy has demonstrated cardiovascular event reduction in a dedicated outcomes trial?
- Niacin
- Ezetimibe (Correct answer)
- Bile acid sequestrant
- Omega-3 ethyl esters (Lovaza)
Correct answer: Ezetimibe
The IMPROVE-IT trial demonstrated that ezetimibe added to simvastatin significantly reduced major cardiovascular events compared to simvastatin alone.
Question 2: Which dietary fat substitution has the greatest evidence for reducing LDL-C when replacing saturated fat?
- Monounsaturated fatty acids
- Polyunsaturated fatty acids (Correct answer)
- Trans fatty acids
- Medium-chain triglycerides
Correct answer: Polyunsaturated fatty acids
Replacing saturated fat with polyunsaturated fatty acids (PUFAs) produces the greatest LDL-C reduction and improves the LDL/HDL ratio.
Question 3: A patient with severe hypertriglyceridemia (TG >1000 mg/dL) is at highest immediate risk for which complication?
- Atherosclerotic cardiovascular disease
- Acute pancreatitis (Correct answer)
- Peripheral neuropathy
- Xanthoma formation
Correct answer: Acute pancreatitis
Severely elevated triglycerides (>1000 mg/dL) pose the greatest immediate risk of acute pancreatitis, which can be life-threatening.
Question 4: Inclisiran differs mechanistically from PCSK9 monoclonal antibodies in that it:
- Blocks PCSK9 binding to LDL receptors
- Inhibits PCSK9 synthesis via RNA interference (Correct answer)
- Upregulates LDL receptor expression directly
- Inhibits hepatic cholesterol synthesis
Correct answer: Inhibits PCSK9 synthesis via RNA interference
Inclisiran is a small interfering RNA (siRNA) that reduces hepatic PCSK9 synthesis, leading to sustained LDL-C lowering with twice-yearly dosing.
Question 5: In the TLC (Therapeutic Lifestyle Changes) diet, what is the recommended daily dietary cholesterol intake?
- < 100 mg/day
- < 200 mg/day (Correct answer)
- < 300 mg/day
- < 500 mg/day
Correct answer: < 200 mg/day
The NCEP TLC diet recommends limiting dietary cholesterol to less than 200 mg/day to reduce LDL-C.
Question 6: Which statin is the most hydrophilic and is least likely to cause CNS side effects such as sleep disturbances?
- Lovastatin
- Simvastatin
- Rosuvastatin (Correct answer)
- Atorvastatin
Correct answer: Rosuvastatin
Rosuvastatin is the most hydrophilic statin, which limits its CNS penetration and is associated with fewer CNS-related adverse effects.
Question 7: A patient cannot tolerate any statin due to myopathy. Which non-statin therapy has demonstrated the most robust LDL-C reduction (up to 50-60%) as monotherapy?
- Ezetimibe
- Colesevelam
- PCSK9 inhibitor (evolocumab) (Correct answer)
- Bempedoic acid
Correct answer: PCSK9 inhibitor (evolocumab)
PCSK9 inhibitors like evolocumab can reduce LDL-C by 50-60% as monotherapy and are a key option for statin-intolerant patients.
CLS Therapeutic Lifestyle & Pharmacologic Interventions 2
A patient on high-intensity statin therapy has LDL-C still above goal.
Which add-on therapy has demonstrated cardiovascular event reduction in a dedicated outcomes trial?