What is the approach to statin-intolerant/familial hypercholesterolemia with insufficient LDL-C lowering?

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Multiple Choice

What is the approach to statin-intolerant/familial hypercholesterolemia with insufficient LDL-C lowering?

When statins can’t be continued or don’t achieve LDL-C goals in familial hypercholesterolemia, the approach is to lower LDL-C further with non-statin therapies rather than stopping treatment. Start by adding ezetimibe, which blocks intestinal cholesterol absorption and provides an additional LDL-C reduction of roughly 15–20% on top of what a statin achieves. If targets are still not reached, escalate to more potent options such as PCSK9 inhibitors or inclisiran, which can lower LDL-C by about 50% or more and are effective in FH patients. Bempedoic acid offers another avenue for further lowering, with an additional modest reduction around 15–20% and is useful for statin-intolerant individuals. Lifestyle measures—dietary changes, weight management, and regular exercise—support the pharmacologic efforts. Discontinuing lipid-lowering therapy would leave LDL-C uncontrolled and increase cardiovascular risk, so it isn’t the appropriate strategy.

When statins can’t be continued or don’t achieve LDL-C goals in familial hypercholesterolemia, the approach is to lower LDL-C further with non-statin therapies rather than stopping treatment. Start by adding ezetimibe, which blocks intestinal cholesterol absorption and provides an additional LDL-C reduction of roughly 15–20% on top of what a statin achieves. If targets are still not reached, escalate to more potent options such as PCSK9 inhibitors or inclisiran, which can lower LDL-C by about 50% or more and are effective in FH patients. Bempedoic acid offers another avenue for further lowering, with an additional modest reduction around 15–20% and is useful for statin-intolerant individuals. Lifestyle measures—dietary changes, weight management, and regular exercise—support the pharmacologic efforts. Discontinuing lipid-lowering therapy would leave LDL-C uncontrolled and increase cardiovascular risk, so it isn’t the appropriate strategy.

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