CLS Therapeutic Lifestyle & Pharmacologic Interventions 3 — Questions and Answers
Question 1: Colesevelam (Welchol) has which unique advantage over older bile acid sequestrants like cholestyramine?
- Greater LDL-C reduction
- Improved glycemic control in type 2 diabetes (Correct answer)
- Does not interfere with fat-soluble vitamin absorption
- Can be used in patients with hypertriglyceridemia
Correct answer: Improved glycemic control in type 2 diabetes
Colesevelam is FDA-approved as an adjunct to improve glycemic control in type 2 diabetes in addition to its LDL-C–lowering effect.
Question 2: The REDUCE-IT trial demonstrated that icosapentaenoic acid (EPA, 4g/day) reduced cardiovascular events by approximately what percentage in statin-treated patients with elevated triglycerides?
- 10%
- 25% (Correct answer)
- 40%
- 55%
Correct answer: 25%
REDUCE-IT showed icosapentaenoic acid (Vascepa) reduced major adverse cardiovascular events by approximately 25% relative to placebo in high-risk statin-treated patients.
Question 3: Which lipoprotein measurement is most directly reduced by niacin therapy, making it useful in patients with isolated low HDL-C?
- LDL-C
- VLDL
- HDL-C (Correct answer)
- Lipoprotein(a)
Correct answer: HDL-C
Niacin produces the largest increase in HDL-C of any available lipid-modifying drug, typically raising it by 15-35%.
Question 4: A patient on gemfibrozil asks about starting rosuvastatin for elevated LDL-C. What is the primary concern with this combination?
- Reduced efficacy of rosuvastatin
- Significantly increased risk of myopathy and rhabdomyolysis (Correct answer)
- Elevated hepatic transaminases requiring monitoring
- Reduced gemfibrozil absorption
Correct answer: Significantly increased risk of myopathy and rhabdomyolysis
Gemfibrozil inhibits statin glucuronidation, dramatically increasing statin plasma levels and the risk of myopathy; fenofibrate is the preferred fibrate when combined with statins.
Question 5: Plant stanols and sterols reduce LDL-C through which primary mechanism?
- Inhibiting HMG-CoA reductase in the liver
- Competing with dietary cholesterol for intestinal absorption (Correct answer)
- Increasing bile acid excretion
- Upregulating LDL receptor expression
Correct answer: Competing with dietary cholesterol for intestinal absorption
Plant stanols and sterols structurally compete with cholesterol for micellar incorporation, reducing intestinal cholesterol absorption by ~30-40%.
Question 6: Bempedoic acid lowers LDL-C by inhibiting which enzyme in the cholesterol synthesis pathway?
- HMG-CoA reductase
- ATP citrate lyase (ACL) (Correct answer)
- Squalene synthase
- Lanosterol synthase
Correct answer: ATP citrate lyase (ACL)
Bempedoic acid inhibits ATP citrate lyase (ACL), an enzyme upstream of HMG-CoA reductase, reducing hepatic cholesterol synthesis.
Question 7: Which physical activity recommendation best aligns with TLC guidelines for cardiovascular risk reduction in lipid management?
- 20 minutes of vigorous exercise 2 days per week
- At least 30 minutes of moderate-intensity exercise most days of the week (Correct answer)
- 90 minutes of low-intensity walking once weekly
- 10 minutes of high-intensity interval training daily
Correct answer: At least 30 minutes of moderate-intensity exercise most days of the week
TLC guidelines recommend at least 30 minutes of moderate-intensity physical activity on most, preferably all, days of the week.
CLS Therapeutic Lifestyle & Pharmacologic Interventions 3
Colesevelam (Welchol) has which unique advantage over older bile acid sequestrants like cholestyramine?