USMLE PRACTICE QUESTION OF THE WEEK

Question for January 30, 2026

A 62-year-old woman with hypertension presents for routine checkup. She has no complaints. She smokes 1 pack/day. BMI is 29 kg/m². BP is 142/86 mmHg, pulse 80/min. Physical exam is unremarkable.

Laboratory studies reveal:
  • Total cholesterol: 246 mg/dL
  • LDL: 158 mg/dL
  • HDL: 41 mg/dL
  • HbA1c: 6.2%
  • Her 10-year ASCVD risk is calculated at 15%.
Which of the following is the most appropriate next step in management?

Correct Answer:

B. High-intensity statin therapy

Correct Answer Explanation:

This patient has LDL >70 and a 10-year ASCVD risk ≥7.5%. Guidelines recommend high-intensity statin (e.g., atorvastatin 40-80 mg, rosuvastatin 20-40 mg). Lifestyle modification is always encouraged but insufficient alone. Ezetimibe/niacin are reserved for patients intolerant or not at goal with statins.

Further Insight:

  • ASCVD risk calculators guide statin therapy in patients 40-75 with LDL 70-189.
  • Smoking cessation is a key parallel intervention.