PH4.11 | PH4.11 | Dyslipidaemia Pharmacotherapy — Summary & Reflection

KEY TAKEAWAYS

Dyslipidaemia pharmacotherapy is built on two pillars: first, achieve the LDL-C target for the patient's cardiovascular risk tier using statins as backbone (high-intensity in secondary prevention) with sequential addition of ezetimibe and PCSK9 inhibitors; second, address elevated triglycerides (fibrate for TG >500 mg/dL to prevent pancreatitis; EPA 4 g/day for TG 135–499 mg/dL in high-CV-risk patients on statin). Statins' most serious ADR is the myopathy spectrum — routinely monitor for symptoms, avoid gemfibrozil combination (use fenofibrate if needed), and check for hypothyroidism in apparently statin-intolerant patients. A key prescribing obligation per PH4.11 is recognising that several commonly used drugs — thiazides, non-selective β-blockers, corticosteroids, OCPs, retinoids, protease inhibitors, and ciclosporin — cause dyslipidaemia and require monitoring. Statins are contraindicated in pregnancy; bile-acid sequestrants are the safe alternative. Evidence from the 4S, JUPITER, IMPROVE-IT, FOURIER, and REDUCE-IT trials anchors the therapeutic decisions in this SDL.

REFLECT

Consider the patient in the opening hook: a 54-year-old male hypertensive with LDL 182 mg/dL, TG 240 mg/dL, and a strong family history. Using the risk framework and prescribing knowledge from this SDL:

1. How would you calculate and classify his 10-year CVD risk?
2. What LDL target applies to him?
3. Which drug, at which dose, would you start — and why?
4. His brother takes losartan; would you worry about drug interactions?
5. At what interval would you recheck his lipids and what other tests would you order?

Reflect on whether your initial gut instinct before this SDL would have matched the evidence-based answer. This case mirrors tens of thousands of outpatient consultations you will conduct in your career.