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Dyslipidemia

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1
When are statins recommended for non-diabetic patients without ASCVD? (Reference: 2020 Philippine CPG)
Aged ≥45 years with LDL-C ≥130 mg/dL AND ≥2 risk factors
2
Risk factors for cardiovascular disease? (Reference: 2020 Philippine CPG)
Male sex, postmenopausal women, smoker, hypertension, BMI >25 kg/m2, family history of premature CHD, proteinuria, and left ventricular hypertrophy
3
Screening recommendations for pediatric population? (Reference: 2020 Philippine CPG)
Selective screening for those at risk. Universal screening to identify those with risk factors for familial hypercholesterolemia at 9-11 years old and 17-21 years old.
4
What LDL-C target is recommended for non-diabetic individuals with no clinical ASCVD? (Reference: 2020 Philippine CPG)
<130 mg/dL
5
What LDL-C target is recommended for most diabetic patients without ASCVD? (Reference: 2020 Philippine CPG)
<100 mg/dL
6
What LDL-C target is recommended for diabetics with >1 risk factor or target organ damage, but no ASCVD? (Reference: 2020 Philippine CPG)
<70 mg/dL
7
What LDL-C target is recommended for diabetics with ASCVD? (Reference: 2020 Philippine CPG)
<55 mg/dL
8
What LDL-C target is recommended for individuals with clinical ASCVD? (Reference: 2020 Philippine CPG)
<55 mg/dL
9
What LDL-C target is recommended for individuals with Familial Hypercholesterolemia without ASCVD or major risk factor/target organ damage? (Reference: 2020 Philippine CPG)
<70 mg/dL
10
What LDL-C target is recommended for individuals with Familial Hypercholesterolemia with ASCVD or >1 risk factor/target organ damage? (Reference: 2020 Philippine CPG)
<55 mg/dL
11
What HDL-C target is recommended for males? (Reference: 2020 Philippine CPG)
>40 mg/dL
12
What HDL-C target is recommended for females? (Reference: 2020 Philippine CPG)
>50 mg/dL
13
What triglyceride target is recommended? (Reference: 2020 Philippine CPG)
<150 mg/dL
14
What is the formula for non-HDL-C? (Reference: 2020 Philippine CPG)
Total cholesterol - HDL-C
15
What is the recommended target non-HDL-C? (Reference: 2020 Philippine CPG)
30 mg/dL above target LDL-C
16
What drug can be added for individuals with documented ACS not reaching target LDL-C despite maximally-tolerated high-intensity statin therapy? (Reference: 2020 Philippine CPG)
Ezetimibe
17
In which population may fibrates be added to statins for prevention of CV disease? (Reference: 2020 Philippine CPG)
Men with controlled diabetes, low HDL-C (<35 mg/dl) and persistently high triglycerides (>200 mg/dl)
18
What drug may be given to ASCVD patients at LDL-C goal but with persistent hypertriglyceridemia? (Reference: 2020 Philippine CPG)
Omega fatty acids (pure EPA)
19
What CK level is considered elevated in the statin-induced myopathy algorithm? (Reference: 2020 Philippine CPG)
>5x ULN
20
If CK is normal in a patient with statin-associated myalgia, what may be done to the statin dose? (Reference: 2020 Philippine CPG)
Continue statin with reduced dose and titrate according to symptoms
21
In a patient with statin-induced rhabdomyolysis, what lipid-lowering therapy can be considered? (Reference: 2020 Philippine CPG)
Discontinue statins (6-week statin holiday);
Ezetimibe + low-dose statin;
Low dose rosuvastatin (alternate or weekly);
PCSK-9 inhibitors; Fibrates or ezetimibe
22
In patients on statins, what AST/ALT threshold requires stopping statin? (Reference: 2020 Philippine CPG)
≥3x ULN
23
In patients with elevated AST/ALT on statins, what medication adjustment is recommended? (Reference: 2020 Philippine CPG)
Resume same statin at lower dose or start other statin with different metabolism;
May use ezetimibe or fibrates if very high risk.
24
How often should adults have lipid profile screening? (Reference: 2026 ACC/AHA)
At least every 5 years, beginning 19 years old
25
At what age should children be screened if not previously tested? (Reference: 2026 ACC/AHA)
9-11 years old
26
In adults on lipid lowering therapy, what marker can guide intensification after LDL-C/non-HDL-C goals are met? (Reference: 2026 ACC/AHA)
ApoB
27
How often should Lp(a) be measured in all adults? (Reference: 2026 ACC/AHA)
At least once
28
What Lp(a) level is considered elevated? (Reference: 2026 ACC/AHA)
≥125 nmol/L or ≥50 mg/dL
29
When should lipids be checked after starting or adjusting lipid lowering therapy? (Reference: 2026 ACC/AHA)
4-12 weeks, and every 6-12 months thereafter
30
LDL-C reduction based on statin intensity? (Reference: 2026 ACC/AHA)
Low-intensity: <30%
Moderate-intensity: 30-49%
High-intensity: ≥50%
31
Which fibrate should not be combined with statins? (Reference: 2026 ACC/AHA)
Gemfibrozil
32
Which fibrate is preferred with statins? (Reference: 2026 ACC/AHA)
Fenofibrate
33
What TG reduction is expected with fibrates? (Reference: 2026 ACC/AHA)
30-50%
34
First-line pharmacologic therapy for patients with TG ≥500 mg/dL to reduce ASCVD? (Reference: 2026 ACC/AHA)
Statins
35
PREVENT-ASCVD is recommended to estimate 10-year risk in which population? (Reference: 2026 ACC/AHA)
Adults aged 30-79 years old with LDL-C 70-189 mg/dl
36
PREVENT-ASCVD 10-year risk estimates? (Reference: 2026 ACC/AHA)
Low: <3%;
Borderline: 3 to <5%;
Intermediate: 5 to <10%;
High: ≥10%
37
What hsCRP level is a risk enhancer? (Reference: 2026 ACC/AHA)
≥2 mg/L on 2 successive occasions
38
Risk enhancers in adults without ASCVD with a borderline 10-y ASCVD risk estimate? (Reference: 2026 ACC/AHA)
History of premature ASCVD in a parent or sibling (onset age <55 y for men, <65 y for women);
Higher risk ancestry (eg, South Asian, Filipino);
High polygenic risk;
Chronic inflammatory diseases;
Lp(a) ≥125 nmol/L or ≥50 mg/dL;
hsCRP ≥2 mg/L on >1 occasion;
TG persistently ≥175 mg/dL (2 mmol/L) (if nonfasting) and ≥150 mg/dL (1.7 mmol/L) (if fasting);
CKM syndrome;
LDL-C persistently ≥160-189 mg/dL (4.1-4.9 mmol/L), non-HDL-C ≥190–219 mg/dL, or apoB ≥120 mg/dL;
Reproductive risk markers
39
Reproductive risk markers associated with ASCVD events? (Reference: 2026 ACC/AHA)
Hypertensive disorders of pregnancy;
Gestational diabetes;
Small-for-gestational age;
Preterm delivery;
Recurrent spontaneous pregnancy loss;
Early menarche (<10 y old);
Early menopause (<45 y old) especially premature menopause (<40 y old);
Polycystic ovarian syndrome and irregular menses
40
Coronary artery calcium (CAC) scoring can be considered in what ages? (Reference: 2026 ACC/AHA)
Men <40 years old; Women <45 years old
41
If lipid lowering therapy is deferred after CAC 0, when should CAC be repeated? (Reference: 2026 ACC/AHA)
3-7 years
42
Exceptions for deferring lipid lowering therapy among intermediate- and borderline-risk adults with CAC 0? (Reference: 2026 ACC/AHA)
Familial hypercholesterolemia;
Severe hypercholesterolemia >190 mg/dL;
Diabetes and age >40 y;
Current cigarette smoking;
Strong family history of premature ASCVD
43
At what CAC score should lipid lowering therapy be initiated? (Reference: 2026 ACC/AHA)
>0 AU in adults at intermediate risk and select adults at borderline risk (especially if CAC ≥100 AU or ≥75th percentile)
44
First line of treatment for the primary prevention of ASCVD? (Reference: 2026 ACC/AHA)
Health behavior counseling
45
In low-risk adults with LDL-C <160 and 30-year risk <10%, what management is recommended? (Reference: 2026 ACC/AHA)
Health behavior counseling
46
In low-risk adults with LDL-C 160-189 or 30-year ASCVD risk ≥10%, what management is reasonable? (Reference: 2026 ACC/AHA)
Moderate-intensity statin
47
In borderline-risk adults starting statins, what intensity is reasonable? (Reference: 2026 ACC/AHA)
Moderate-intensity statin
48
In intermediate-risk adults, what statin intensity is recommended? (Reference: 2026 ACC/AHA)
Moderate- to high-intensity statin
49
What LDL-C goal is reasonable for primary prevention in borderline- and intermediate-risk adults? (Reference: 2026 ACC/AHA)
<100 mg/dL
50
What non-HDL-C goal is reasonable for primary prevention in borderline- and intermediate-risk adults? (Reference: 2026 ACC/AHA)
<130 mg/dL
51
In high-risk adults, what statin intensity is recommended? (Reference: 2026 ACC/AHA)
High-intensity statin
52
What LDL-C goal is reasonable for primary prevention in high-risk adults? (Reference: 2026 ACC/AHA)
<70 mg/dL
53
What non-HDL-C goal is reasonable for primary prevention in high-risk adults? (Reference: 2026 ACC/AHA)
<100 mg/dL
54
In high-risk adults on maximally tolerated statin, what drug is reasonable to add if LDL-C and non-HDL-C goals are not achieved? (Reference: 2026 ACC/AHA)
Ezetimibe
55
In high-risk adults on maximally tolerated statin with or without ezetimibe, what drug may be reasonable to add if LDL-C and non-HDL-C goals are not achieved? (Reference: 2026 ACC/AHA)
PCSK9 mAb or bempedoic acid
56
What LDL-C defines severe hypercholesterolemia? (Reference: 2026 ACC/AHA)
≥190 mg/dL
57
In severe hypercholesterolemia, what is the recommended pharmacotherapy? (Reference: 2026 ACC/AHA)
Maximally tolerated statin
58
In severe hypercholesterolemia without ASCVD/FHisk factors, what LDL-C goal is used? (Reference: 2026 ACC/AHA)
<100 mg/dL
59
In severe hypercholesterolemia with FHisk factors/subclinical atherosclerosis but no ASCVD, what LDL-C goal is used? (Reference: 2026 ACC/AHA)
<70 mg/dL
60
In severe hypercholesterolemia with ASCVD, what LDL-C goal is used? (Reference: 2026 ACC/AHA)
<55 mg/dL
61
In severe hypercholesterolemia with ASCVD, what non-HDL-C goal is used? (Reference: 2026 ACC/AHA)
<85 mg/dL
62
In severe hypercholesterolemia with LDL-C ≥100 despite maximally tolerated statin with or without ezetimibe, what drug is reasonable to add? (Reference: 2026 ACC/AHA)
Inclisiran
63
In diabetic adults aged 40-75 without ASCVD, what statin is recommended? (Reference: 2026 ACC/AHA)
Moderate-intensity statin
64
In diabetic adults aged 40-75 without ASCVD, what LDL-C goal is recommended? (Reference: 2026 ACC/AHA)
<100 mg/dL
65
In diabetic adults aged 40-75 with multiple ASCVD risk factors, what statin is reasonable to prescribe? (Reference: 2026 ACC/AHA)
High-intensity statin
66
In diabetic adults aged 40-75 with multiple ASCVD risk factors, what LDL-C goal is reasonable? (Reference: 2026 ACC/AHA)
<70 mg/dL
67
In diabetic adults with statin-attributed side effects, what medications are recommended? (Reference: 2026 ACC/AHA)
Ezetimibe, bempedoic acid, or PCSK9 mAb
68
In diabetic adults without ASCVD but with ASCVD risk factors and TG 150-499, what may be considered? (Reference: 2026 ACC/AHA)
Icosapent ethyl
69
In diabetic adults aged 20-39 with ASCVD risk factors, what statin may be reasonable to prescribe? (Reference: 2026 ACC/AHA)
Moderate-intensity statin
70
In adults with clinical ASCVD, what statin is recommended? (Reference: 2026 ACC/AHA)
High-intensity statin
71
In adults with clinical ASCVD not at very high risk, what LDL-C goal is recommended? (Reference: 2026 ACC/AHA)
<70 mg/dL
72
In adults with ASCVD not at very high risk, what non-HDL-C goal is recommended? (Reference: 2026 ACC/AHA)
<100 mg/dL
73
In adults with ASCVD at very high risk, what LDL-C goal is recommended? (Reference: 2026 ACC/AHA)
<55 mg/dL
74
In adults with ASCVD at very high risk, what non-HDL-C goal is recommended? (Reference: 2026 ACC/AHA)
<85 mg/dL
75
In adults with ASCVD at very high risk and not at goal LDL-C despite maximally tolerated statin therapy, what should be added? (Reference: 2026 ACC/AHA)
Ezetimibe and/or PCSK9 mAb
76
In adults with ASCVD at very high risk, what oral nonstatin is reasonable as add-on therapy? (Reference: 2026 ACC/AHA)
Bempedoic acid or inclisiran
77
In adults with a CAC score of ≥1000 AU, what LDL-C goal is recommended? (Reference: 2026 ACC/AHA)
<55 mg/dL
78
In adults with a CAC score of ≥100 AU, what LDL-C goal is recommended? (Reference: 2026 ACC/AHA)
<70 mg/dL
79
In adults with a CAC score of 1-99 AU, what LDL-C goal is recommended? (Reference: 2026 ACC/AHA)
<100 mg/dL
80
In adults with no prior ASCVD but with incidental findings of moderate-to-severe coronary atherosclerosis on CT, what statin is reasonable? (Reference: 2026 ACC/AHA)
High-intensity statin
81
In adults with no prior ASCVD but with incidental findings of mild coronary atherosclerosis on CT, what statin is reasonable? (Reference: 2026 ACC/AHA)
Moderate-intensity statin
82
In children with lipid abnormalities, what is recommended? (Reference: 2026 ACC/AHA)
Lifestyle management
83
In which pediatric population is lipid lowering therapy recommended? (Reference: 2026 ACC/AHA)
Children and adolescents ≥8 years of age with an LDL-C level persistently ≥160 mg/dL and a presentation consistent with FH who do not respond sufficiently after 3 to 6 months of lifestyle management
84
In young adults >18-39 years, what is the main recommendation? (Reference: 2026 ACC/AHA)
Lifestyle optimization
85
When should individuals of childbearing age with hypercholesterolemia but not high risk for ASCVD stop statin therapy? (Reference: 2026 ACC/AHA)
1-2 months before attempting pregnancy or as soon as pregnancy is discovered
86
In pregnant individuals with severe hypertriglyceridemia (TG ≥500), what medications are reasonable as adjunct to lifestyle management? (Reference: 2026 ACC/AHA)
Fibrates (after 1st trimester) or high-dose omega-3 ethyl esters
87
In pregnant or lactating individuals with hypercholesterolemia but without hypertriglyceridemia, what medication is reasonable to lower LDL-C? (Reference: 2026 ACC/AHA)
Bile acid sequestrants
88
In adults aged 40-75 with CKD stage ≥3 and LDL-C 70-189, what treatment is recommended? (Reference: 2026 ACC/AHA)
Moderate-intensity statin with or without ezetimibe
89
In adults with CKD stage ≥3 and clinical ASCVD, what treatment is recommended? (Reference: 2026 ACC/AHA)
High-intensity statin with or without ezetimibe and/or PCSK9 mAb
90
In PLHIV aged 40-75 on stable combination ART, what is recommended to reduce risk of ASCVD and rate of atherosclerosis? (Reference: 2026 ACC/AHA)
Statin therapy
91
In adults with active cancer already on statin, when should statin be stopped? (Reference: 2026 ACC/AHA)
If with drug interaction or life expectancy <1 year
92
In adults with persistently elevated TG levels ≥150 mg/dL, what is the recommended first-line treatment to reduce TG levels? (Reference: 2026 ACC/AHA)
Lifestyle management
93
In adults with clinical ASCVD not at goal LDL-C despite maximally tolerated statin and with persistently elevated TG levels, what is recommended to reduce ASCVD risk? (Reference: 2026 ACC/AHA)
Intensification of LDL-lowering therapy
94
In patients with Familial Chylomicronemia Syndrome and TG ≥1000 mg/dL, what medication is recommended as adjunct to diet? (Reference: 2026 ACC/AHA)
Olezarsen
95
In adults ≥50 years with ASCVD or diabetes plus risk factors on maximally tolerated statin and with persistently elevated TG, the addition of what medication may be reasonable? (Reference: 2026 ACC/AHA)
Icosapent ethyl
96
In adults with severe hypertriglyceridemia (persistently elevated TG ≥500) despite dietary intervention, what medications are reasonable to give? (Reference: 2026 ACC/AHA)
Fibrates or prescription omega-3 fatty acids
97
In adults with hypertriglyceridemia, what markers are preferred over LDL-C in estimating ASCVD risk? (Reference: 2026 ACC/AHA)
Non-HDL-C or apoB
98
In elevated Lp(a), what management is recommended early? (Reference: 2026 ACC/AHA)
Risk factor control
99
In ASCVD with elevated Lp(a) not at lipid goals despite maximally tolerated statin, the addition of what drug is recommended? (Reference: 2026 ACC/AHA)
PCSK9 mAb
100
In adults with statin-attributed muscle symptoms (SAMS), what laboratory is recommended? (Reference: 2026 ACC/AHA)
Creatine kinase
101
What pattern supports statin-attributed muscle symptoms? (Reference: 2026 ACC/AHA)
Bilateral proximal symptoms
102
In adults with clinical ASCVD not at goal LDL-C with SAMS, what medication strategy is recommended? (Reference: 2026 ACC/AHA)
Reduced statin dose (if tolerable) and add bempedoic acid, ezetimibe, or PCSK9 mAb
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