Which of the following is considered first-line therapy for reducing the risk of atherosclerotic cardiovascular disease (ASCVD)?

HMG-CoA reductase inhibitors, commonly known as statins, are the cornerstone and first-line pharmacologic therapy for the primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). Major clinical practice guidelines, such as those from the American College of Cardiology/American Heart Association (ACC/AHA), unequivocally recommend statin therapy for eligible patients based on their ASCVD risk profile. Statins effectively lower low-density lipoprotein cholesterol (LDL-C), a primary driver of atherosclerosis, and have extensive evidence from large-scale clinical trials demonstrating a significant reduction in major adverse cardiovascular events, including myocardial infarction and stroke.

B. Bile acid resins: These are considered second-line or add-on agents, often for patients who are statin-intolerant or require additional LDL-C lowering.
C. Nicotinic Acid: Its use has declined significantly as major clinical trials failed to show an incremental cardiovascular benefit when added to statin therapy.
D. Fibrates: These are primarily used to treat severe hypertriglyceridemia and are not first-line for general ASCVD risk reduction focused on LDL-C.
E. Fish oil: Primarily indicated for managing hypertriglyceridemia; it is not a first-line monotherapy for primary ASCVD prevention.

1. Grundy

S. M.

Stone

N. J.

Bailey

A. L.

et al. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation

139(25)

e1082–e1143. (See Section 4.3

"Primary Prevention

" Recommendation 1

which states

"In all individuals

emphasize a heart-healthy lifestyle... For patients with ASCVD

reduce LDL-C with high-intensity statin therapy or maximally tolerated statin therapy.") DOI: https://doi.org/10.1161/CIR.0000000000000625

2. Hilal-Dandan

R.

& Brunton

L. L. (Eds.). (2021). Goodman & Gilman's The Pharmacological Basis of Therapeutics (14th ed.). McGraw-Hill Education. (In Chapter 33

"Drug Therapy for Hypercholesterolemia and Dyslipidemia

" the text establishes statins as the most effective and widely used drugs for managing plasma cholesterol levels and preventing ASCVD.)

3. University of California

San Francisco School of Pharmacy. (n.d.). Cardiovascular & Renal Pharmacotherapy Course Materials. In the Dyslipidemia module

statins are presented as the first-line drug class for the management of hypercholesterolemia and ASCVD risk reduction based on overwhelming clinical trial evidence. (Specific course materials on dyslipidemia management consistently identify statins as the initial and primary intervention.)