American Board of Internal Medicine (ABIM) Certification Practice Exam

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In adults aged 40 to 75 with diabetes and a 10-year atherosclerotic cardiovascular disease risk of 7.5% or higher, what LDL cholesterol level warrants high-intensity statin therapy?

50 to 150 mg/dL
60 to 160 mg/dL
70 to 189 mg/dL
80 to 200 mg/dL

The correct answer is: 70 to 189 mg/dL

High-intensity statin therapy is recommended for adults aged 40 to 75 with diabetes who also have a calculated 10-year atherosclerotic cardiovascular disease (ASCVD) risk of 7.5% or higher. The specific LDL cholesterol level that indicates the need for this level of treatment is 70 to 189 mg/dL. This range of LDL cholesterol levels is clinically significant because individuals within it who also have the described risk factors are at an increased risk for cardiovascular events. Therefore, initiating high-intensity statin therapy can effectively lower LDL levels and subsequently reduce the risk of these events. Statins work by inhibiting cholesterol synthesis in the liver, leading to a reduction in circulating LDL cholesterol levels, which is crucial for patients in this high-risk group. Lowering LDL cholesterol to below 70 mg/dL can provide additional cardiovascular protection; thus, identifying patients with LDL levels in that range informs the choice of high-intensity statin therapy to achieve optimal management of their cardiovascular risk.