American Board of Internal Medicine (ABIM) Certification Practice Exam

At what LDL level should high-intensity statin therapy be initiated regardless of other factors?

1. 160 mg/dL

2. 190 mg/dL

3. 200 mg/dL

4. 210 mg/dL

The correct answer is: 190 mg/dL

High-intensity statin therapy should be initiated when the LDL cholesterol level reaches 190 mg/dL or higher, regardless of other risk factors. This recommendation is based on clinical guidelines that recognize this level as indicative of a significantly increased risk for atherosclerotic cardiovascular disease. The rationale for starting treatment at this threshold is that individuals with very high LDL levels are at a greater risk of developing cardiovascular events, such as heart attacks and strokes. High-intensity statins are effective in significantly lowering LDL levels and, consequently, reducing the risk of these events. Other LDL levels mentioned, such as 160 mg/dL, 200 mg/dL, and 210 mg/dL, do not trigger a universal recommendation for high-intensity statin therapy. While individuals with these levels may still benefit from statin therapy, especially if they have other risk factors, they do not meet the specific threshold that mandates high-intensity therapy regardless of additional conditions. Therefore, the guideline's emphasis on starting treatment at 190 mg/dL is a critical aspect of preventive cardiovascular care.