Assessing acute myocardial infarction questions
A 50‐year‐old male presents with elevated plasma
levels of total cholesterol (285mg/dl), LDL cholesterol (147mg/dl), and triglycerides (164mg/dl). He
has a family history of early cardiovascular disease.
Which of the following drugs if prescribed as monotherapy would most likely and most significantly
reduce the risk of acute myocardial infarction in this
patient?
A. Atorvastatin
B. Colestipol
C. Ezetimibe
D. Gemfibrozil
E. Niacin
4.12.5 The ENHANCE trial involving 720 patients with
heterozygous familial hypercholesterolemia showed
no significant differences in the primary endpoint
[mean change in the intima‐media thickness (IMT)
measured at three sites in the carotid arteries]
between patients treated with ezetimibe/simvastatin
(10/80mg) and patients treated with simvastatin
(80mg) alone over a 2‐year period, though ezetimibe/
simvastatin group showed a more significant
decrease in LDL‐C (58% vs. 41%). What is the
mechanism of action of ezetimibe in further lowering
cholesterol in statin‐treated patients?
A. Ezetimibe binds to, and interrupts, bile acid and
cholesterol enterohepatic circulation
B. Ezetimibe displaces cholesterol from chylomicrons and facilitates its transport to the liver
C. Ezetimibe displaces dietary cholesterol from
micelles and enhances its loss in the feces
D. Ezetimibe inhibits cholesterol incorporation into
VLDL in the liver
E. Ezetimibe inhibits cholesterol uptake through a
brush border cholesterol transporting protein on
enterocytes
4.12.6 In 1976, Dr A. Endo of Japan discovered the first
potent and selective inhibitor of HMG‐CoA reductase, named ML‐236B. Now, HMG‐CoA reductase
inhibitors approved by the US FDA are the most frequently used and well‐studied lipid‐lowering drugs.
Among the clinically available statins, which of the
following is the most potent inhibitor of HMG‐CoA
reductase?
A. Atorvastatin
B. Fluvastatin
C. Lovastatin
D. Pitavastatin
E. Pravastatin
Assessing acute myocardial infarction questions
4.12.7 Statins have become the mainstay of therapy for
treating high blood cholesterol to reduce the risk of
atherosclerotic cardiovascular diseases. In addition
to reducing LDL‐cholesterol levels, statins have also
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