Calculate The Risk
A healthy 24-year-old adult with a normal lipid profile five years ago and has no additional ASCVD risk factors. According to the guideline’s screening schedule, what routine test is now due?
repeat Lipid Profile
Under the 2026 guideline COR 1, this should be measured at least once in every adult for ASCVD risk assessment.
Lipoprotein(a) or Lp(a)
A patient asks whether red yeast rice, garlic, cinnamon, turmeric, fish oil, or plant sterols can replace prescribed lipid-lowering medication. What does the guideline recommend?
Dietary supplements are not recommended to lower LDL-C or triglycerides
A nonfasting lipid panel reports triglycerides of 238 mg/dL and uses the Friedewald equation. Name one equation preferred by the 2026 guideline.
Martin/Hopkins equation?
OR
The Sampson/NIH equation
A patient begins high-intensity statin therapy today. When should the first follow-up lipid profile generally be obtained.
In 4 to 12 weeks
The 2026 guideline replaces the Pooled Cohort Equations with this risk calculator for adults aged 30 to 79 years without ASCVD or subclinical atherosclerosis and with LDL-C of 70 to 189 mg/dL. Name the Risk Calculator?
Prevent ASCVD
61-year-old patient with diabetes and triglycerides of 260 mg/dL has achieved LDL-C and non–HDL-C goals. Which additional test is reasonable to determine whether residual atherogenic particle burden warrants further treatment?
Apolipoprotein B, or apoB
A patient has fasting triglycerides of 720 mg/dL and regularly consumes alcohol. How much alcohol is okay per new guideline?
Complete alcohol avoidance and individualized restriction of total fat
A patient has a borderline 10-year PREVENT-ASCVD risk. His hsCRP is 2.6 mg/L and remains 2.4 mg/L when repeated, with no identifiable underlying cause. What statin intensity can be useful?
High-intensity statin therapy
A patient with triglycerides of 320 mg/dL wants to exercise to improve the lipid profile. Give the weekly aerobic target and resistance-training frequency.
Hint : ___ mins of Physical Activity, ____ days/week
At least 150 minutes of moderate-to-vigorous aerobic activity per week and resistance exercise two days per week
A 38-year-old woman has a borderline PREVENT-ASCVD risk. Name two reproductive-history findings that may personalize her risk assessment and favor lipid-lowering therapy.
Early menopause before age 45 and an adverse pregnancy outcome (gestational hypertension/preecalmpsia/gestational diabetes/preterm delivery)
A patient with ASCVD, diabetes, and triglycerides of 240 mg/dL has reached LDL-C and non-HDL-C goals, but ApoB remains elevated. What should be considered next?
Adding or intensifying nonstatin lipid-lowering therapy (e.g., ezetimibe, PCSK9 inhibitor, or other appropriate therapy) after reassessing overall ASCVD risk
43-year-old woman with triglycerides of 220 mg/dL has an LDL-C at goal but an elevated apoB. Explain the discordance and its therapeutic implication.
Persistently elevated Apo-B needs intensification of anti-lipid therapy despite normal LDL.
Rationale: Cholesterol depleted particles maybe increased in number, so elevated apoB identifies persistent atherogenic burden
A patient has triglycerides of 380 mg/dL and asks for a bile acid sequestrant because it is not systemically absorbed. Why is this a poor choice?
Bile acid sequestrants may increase triglycerides and should be avoided when triglycerides are at least 300 mg/dL
36-year-old man has an Lp(a) of 142 nmol/L. His sister and adult son have never been tested. What should be done next?
Cascade Lp(a) testing of first-degree relatives
A patient has a CAC(Coronary Calcium Score) score of zero and prefers not to start lipid-lowering therapy. In the absence of higher-risk conditions, when should repeat CAC testing be considered?
3-7 Years
A 72-year-old man without known ASCVD has moderate-to-severe coronary calcification incidentally noted on a nongated chest CT. What treatment intensity and LDL-C response should be pursued?
High-intensity statin therapy, at least a 50% LDL-C reduction, and an LDL-C goal below 70 mg/dL
A patient has Triglycerides on non fasting lipid profile as 480 mg/dl. What is next best step.
Repeat a Fasting Lipid profile whenever TG > 300 on non-fasting lipid profile.
A patient’s Lp(a) is reported as 250 nmol/L. Approximately how much higher is the patient’s ASCVD risk compared with the population median?
Lp(a) of 125 nmol/L corresponds to about a 1.4-fold risk, 250 nmol/L to about a twofold risk, and 430 nmol/L to about a fourfold risk.
The 2026 guideline summarizes these data in its Top Take-Home Messages:
A 67-year-old patient taking atorvastatin has severe hypertriglyceridemia. Which fibrate should be avoided, and what is the preferred safer option?
Avoiding gemfibrozil and using fenofibrate or fenofibric acid
Why?
Gemfibrozil inhibits statin metabolism by:
Causes to have Myopathy, Myositis, Rhabdomyolysis
A 46-year-old man without ASCVD has an LDL-C of 168 mg/dL, a 10-year PREVENT-ASCVD risk of 2.4%, and a 30-year risk of 13%. What treatment is reasonable, and why?
Moderate-intensity statin therapy to reduce cumulative lifetime exposure to atherogenic lipoproteins
A patient without clinical ASCVD has a CAC score of 1,120. State the percentage LDL-C reduction, LDL-C goal, and non–HDL-C goal?
At least a
50% LDL-C reduction
LDL-C below 55 mg/dL
Non–HDL-C below 85 mg/dL
A patient has triglycerides of 1,350 mg/dL despite lifestyle modification and is taking a statin. The team is considering gemfibrozil, over-the-counter fish oil, or fenofibrate. Select the preferred option and explain why the other two are inappropriate.
Fenofibrate.
Gemfibrozil should not be combined with a statin because of muscle toxicity, and nonprescription fish oil is not equivalent to prescription omega-3 therapy.
An injectable therapy administered every six months after the initial and three-month doses. Name the therapy, its mechanism of action.
Inclisiran, a small-interfering RNA that promotes degradation of PCSK9 mRNA.
It lowers LDL-C by approximately 48% to 52%
A statin-intolerant patient with high ASCVD risk needs an additional oral agent.
Which medication activated primarily in the liver that inhibits ATP citrate lyase upstream of HMG-CoA reductase.
Name the drug
its expected LDL-C reduction as monotherapy(bonus) .
Bempedoic acid, with an approximately 21% to 24% LDL-C reduction