Hypercholesterolemia: The Daily PANCE Blueprint
A 52-year-old man with coronary artery disease is found to have an LDL cholesterol of 178 mg/dL on a routine check-up. He has tried maximally tolerated doses of atorvastatin and ezetimibe without reaching his LDL goal of <100 mg/dL. Which of the following medications is the most appropriate to add next?
A. Niacin
B. Fenofibrate
C. Gemfibrozil
D. Evolocumab
E. Bezafibrate
Answer and topic summary
The answer is D) Evolocumab
This patient with clinical atherosclerotic cardiovascular disease has severe hypercholesterolemia not adequately controlled by maximum statin and ezetimibe (Zetia) therapy. The next recommendation is to add a PCSK9 inhibitor such as evolocumab to further lower LDL. Niacin, fibrates, and other non-statin agents have less evidence for ASCVD risk reduction compared to PCSK9 inhibition. In patients who have drug-resistant hypercholesterolemia, management decisions may be complicated, and referral to a specialist who has substantial expertise in managing such individuals is appropriate.
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Covered under ⇒ PANCE Blueprint Cardiology ⇒ ⇒
