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Chapter 5. Dyslipidemia

HG is a 45-year-old woman who has been diagnosed with dyslipidemia for over a year, she has tried lifestyle modification for 3 months and was started on atorvastatin 40 mg daily about 6 months ago. Her most recent labs indicate low density lipoprotein-cholesterol (LDL-C) of 120 mg/dL. She is reluctant to try another statin as she believes atorvastatin has been working well for her despite a 25% reduction in LDL-C. Which of the following medications would you recommend in addition to continued lifestyle modification for patient HG?

a. Alirocumab 75 mg/mL

b. Ezetimibe 10 mg

c. Omega-3-acid ethyl esters

d. Rosuvastatin 20 mg

Answer b is correct. Statins should decrease LDL-C by at least 50%, seeing as there was only a 25% decrease in LDL-C, another agent added would be the most appropriate.

Answer a is incorrect. It could be added later on if ezetimibe fails in addition to concomitant lifestyle modifications and if the statin is at its maximally tolerated strength.

Answer c is incorrect. Omega-3-acid ethyl esters are more effective on triglycerides (TGs) than LDL-C.

Answer d is incorrect. Adding another statin to atorvastatin would not be appropriate.

HG is a 45-year-old woman who has been diagnosed with dyslipidemia for over a year, she has tried lifestyle modification for 3 months and was started on atorvastatin 40 mg daily about 6 months ago. Her most recent labs indicate low density lipoprotein-cholesterol (LDL-C) of 120 mg/dL. She is reluctant to try another statin as she believes atorvastatin has been working well for her despite a 25% reduction in LDL-C. It is decided that alirocumab 75 mg/mL will be initiated for HG. What of the following criteria is (are) most appropriate for the initiation of alirocumab? Select all that apply.

a. Adults with familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease (ASCVD)

b. History of myalgias on statin therapy

c. On a maximum tolerated statin therapy and adjunctive lifestyle modifications

d. Trial of lifestyle modifications for 3 months

Answers a and c are correct. Patient needs to have met the criteria listed of familial hypercholesterolemia or clinical ASCVD, on a maximum tolerated statin dose and partake in adjunctive lifestyle modifications.

Answer b is incorrect. Myalgias can be experienced but is not a reason for criteria to initiate alirocumab, other agents can be tried prior to initiating alirocumab. Another statin could be initiated that was hydrophilic could reduce the likelihood of ...

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