Correct. Chylomicrons are triglyceride (TG)-rich lipoproteins and elevated TG levels are associated with higher risk of ASCVD.

Correct. Numerous studies have consistently demonstrated a log-linear relationship between the absolute changes in plasma LDL-C and the risk of ASCVD. LDL-C is causally associated with the risk of ASCVD.

Incorrect. The inverse association between plasma HDL-C and the risk ofASCVD is widely established. Interestingly, there is no evidence from randomized trials that therapeutically increasing plasma HDL-C reduces the risk of CV events.

Correct. Higher plasma Lp(a) concentrations (>105 nmol/l) are associated with higher risk of ASCVD and aortic valve stenosis. Data aresuggesting that high Lp(a) may confer a higher risk than LDL-C.

Incorrect. 2.6 mmol/l or lower is a treatment goal for moderate risk patients.

Incorrect. 1.8 mmol/l or lower is a treatment goal for very high risk patients.

Correct. In secondary prevention an LDL-C reduction of >50% from baseline and an LDL-C goal of <1.4 mmol/L are recommended.

Incorrect. 1 mmol/l or lower is intended for patients with ASCVD who experiencerecurrent vascular events while takingmaximally tolerated statin-based therapy and patients with polyvascular arterial disease.

Incorrect. This is a recommended treatment goal for very high risk patients.

Incorrect. This is a recommended treatment goal for "extreme" risk patients.

Incorrect. No level of LDL-C below which benefit ceases or harm occurs has been defined.

Correct. No level of LDL-C below which benefit ceases or harm occurs has been defined.

Incorrect. Alcohol intake has a major impact on TG levels, LDL-C change is not that significant.

Incorrect. Unsaturated fat-rich oils from safflower, sunflower, corn, olives, or soybean were shown to reduce LDL-C levels (-0.42 to -0.20 mmol/L).

Correct. Saturated fatty acids (SFAs) are the dietary factor with the greatestimpact on LDL-C levels (0.02 - 0.04 mmol/L ofLDL-C increase for every additional 1% energy coming from saturated fat)

Incorrect. Habitual consumption of significant amounts (>10% energy) ofdietary fructose contributes to TG elevation, LDL-C change is not that significant.

Correct. Daily consumption of 2 g of phytosterols can effectively lower TCand LDL-C levels by 7 - 10% in humans, while it has little or no effect on HDLC and TG levels.

Correct. A clinicallyrelevant hypocholesterolaemic effect (up to a 20% reduction) hasbeen observed with red yeast rice preparations providing a dose of 2.5 - 10 mg monacolin K per day.

Correct. Evidence consistently demonstrates a TC- and LDL-Lowering effect of b-glucan, a viscous fibre from oat and barley. However, the dosage needed to achieve a clinically relevant reduction in levels of LDL-C of3 - 5% varies from 3 - 10 g per day.

Correct. Consumption of fish (at leasttwice a week) and vegetable foods rich in n-3 fatty acids (walnuts, some vegetables, and some seed oils) is associated with lower risk of CV death and stroke, but has no major effects on plasma lipoprotein metabolism.

Incorrect. Generally, this is not a first-line medication, unless statin-based regimen is not tolerated.

Incorrect. Generally PCSK9 is not a first-line therapy.

Correct. It is recommended that a high-intensity statin is prescribed to reach the goals set for the specific level of risk.

Incorrect. Dietary fibre has insufficient effect to be used as first line medication.

Incorrect. Although this is in lower range of usual high-intensity dosage, for some patients, it may not be enough while some patients may not tolerate this dosage.

Incorrect. Although this is in higher range of usual high-intensity dosage, for some patients, it may not be enough while some patients may not tolerate this dosage.

Incorrect. This is an intensified dosage regimen, for some patients, it may not be enough while some patients may not tolerate this dosage.

Correct. It is recommended that a high-intensity statin is prescribed up to the highest tolerated dose to reach the goals set for thespecific level of risk.

Incorrect. This is not the mechanism of action of statins.

Correct. Statins reduce the synthesis of cholesterol in the liver by competitivelyinhibiting the enzyme HMG-CoA reductase, the rate-limiting step in cholesterol biosynthesis.

Incorrect. This is not the mechanism of action of statins.

Incorrect. This is not the mechanism of action of statins.

Incorrect. Statins only marginally affect Lp(a) plasma levels. Previous studies have reported either no effect on or an increase ofLp(a) levels after statin treatment.

Correct. Statins only marginally affect Lp(a) plasma levels. Previous studies have reported either no effect on or an increase ofLp(a) levels after statin treatment.

Incorrect. Statins only marginally affect Lp(a) plasma levels. Previous studies have reported either no effect on or an increase ofLp(a) levels after statin treatment.

Incorrect. No such contraindication exists.

Incorrect. Mild elevation of ALT occurs in 0.5 - 2.0% of patients on statintreatment, more commonly with potent statins or high doses but there is no indication that statins cause any worsening of liver disease.

Correct. Myopathy is the most clinically relevant adverse effect of statins. 1-3 cases/100 000 patient-years can develop rhabdomyolysis.

Incorrect. Patients on statin treatment have been shown to exhibit an increased risk of dysglycaemia and development of type 2 DM. Overall, the absolute reduction in the risk of CVD in high-risk patients clearly outweighs the possible adverse effects of a small increase in the incidence of diabetes.

Incorrect. Meta-analyses yielded conflicting findings and there is a need for further exploration of the risk of haemorrhagic stroke in particular types of patients.

Correct. Statin therapy may interfere with thecatabolism of this drug metabolized by the same enzymatic system.

Correct. Statin therapy may interfere with thecatabolism of this drug metabolized by the same enzymatic system.

Correct. Statin therapy may interfere with thecatabolism of this drug metabolized by the same enzymatic system.

Correct. Statin therapy may interfere with thecatabolism of this drug metabolized by the same enzymatic system.

Incorrect. HEART Score for Major Cardiac Events predicts 6-week risk of major adverse cardiac events in patients with chest pain.

Correct. SCORE2 (Systematic Coronary Risk Evaluation 2) is endorsed to use in this context.

Incorrect. GRACE score estimates admission to 6 month mortality for patients with acute coronary syndrome.

Incorrect. CHA₂DS₂-VA score calculates stroke risk for patients with atrial fibrillation.

Incorrect. This is not a recommended next step in pharmacological treatment.

Correct. If the goals are not achieved with the maximum tolerated dose of a statin, combination with ezetimibe isrecommended.

Incorrect. This is not a recommended next step in pharmacological treatment.

Incorrect. This is not a recommended next step in pharmacological treatment.

Incorrect. Ezetimibe does not directly modulate SREBP or hepatic LDL receptor expression, its action occurs in the intestinal brush border, blocking cholesterol absorption.

Incorrect. Ezetimibe does not interact with PPAR-α, its effect on cholesterol is independent of fatty acid oxidation.

Incorrect. Ezetimibe does not bind bile acids, it inhibits the NPC1L1 transporter responsible for cholesterol uptake.

Correct. Ezetimibe inhibits intestinal uptake of dietary and biliary cholesterolat the level of the brush border of the intestine [by interacting with the Niemann-Pick C1-like protein 1 (NPC1L1)] without affecting the absorption of fat-soluble nutrients.

Incorrect. Ezetimibe added to ongoing statin therapy reduces LDL-C levelsby an additional 21 - 27%.

Incorrect. Ezetimibe added to ongoing statin therapy reduces LDL-C levelsby an additional 21 - 27%.

Correct. Ezetimibe added to ongoing statin therapy reduces LDL-C levelsby an additional 21 - 27%.

Incorrect. Ezetimibe added to ongoing statin therapy reduces LDL-C levelsby an additional 21 - 27%.

Incorrect. This medication is not the first-line choice in this situation.

Correct. For secondary (and primary in some cases) prevention, patients at very high risk not achieving their goal on a maximum tolerated dose of a statin andezetimibe, a combination with a PCSK9 inhibitor is recommended.

Incorrect. This medication is not the first-line choice in this situation.

Incorrect. Haemodialysis is not the first-line choice in this situation.

Incorrect. This is not the mechanism of action.

Correct. mAbs reduce the plasma level ofPCSK9, which in turn is not available to bind the LDLR. Since this interaction triggers the intracellular degradation of the LDLR,lower levels of circulating PCSK9 will result in increased expression of LDLRs at the cell surface and therefore in a reduction ofcirculating LDL-C levels.

Incorrect. This is not the mechanism of action.

Incorrect. This is not the mechanism of action.

Incorrect. In clinical trials, alirocumaband evolocumab—either alone or in combination with statins, and/orother lipid-lowering therapies—have been shown to significantlyreduce LDL-C levels on average by 60%.

Incorrect. In clinical trials, alirocumaband evolocumab—either alone or in combination with statins, and/orother lipid-lowering therapies—have been shown to significantlyreduce LDL-C levels on average by 60%.

Incorrect. In clinical trials, alirocumaband evolocumab—either alone or in combination with statins, and/orother lipid-lowering therapies—have been shown to significantlyreduce LDL-C levels on average by 60%.

Correct. In clinical trials, alirocumaband evolocumab—either alone or in combination with statins, and/orother lipid-lowering therapies—have been shown to significantlyreduce LDL-C levels on average by 60%.

Correct. In contrast to statins, inhibiting PCSK9 with mAbs also reduces Lp(a) plasma levels by about 30 - 40%.

Incorrect. In contrast to statins, inhibiting PCSK9 with mAbs also reduces Lp(a) plasma levels by about 30 - 40%.

Incorrect. In contrast to statins, inhibiting PCSK9 with mAbs also reduces Lp(a) plasma levels by about 30 - 40%.

Incorrect. No such contraindication exists.

Incorrect. Not primary choice, fibrates primarily lower triglycerides.

Correct. Bempedoic acid is an oral small molecule that inhibits cholesterol synthesis by inhibiting the action of ATP-citrate lyase, a cytosolic enzyme upstream of HMG-CoA reductase. Bempedoic acid is recommended in patients who are unable to take statin therapy to achieve the LDL-C goal.

Incorrect. Niacin modestly lowers LDL-C but is not recommended due to limited cardiovascular benefit.

Incorrect. Coenzyme Q10 is often used for muscle symptoms, but it does not lower LDL-C.

Incorrect. This medication does not exist.

Incorrect. This medication does not exist.

Correct. Inclisiran, a small interfering ribonucleic acid (RNA) molecule that inhibits the synthesis of PCSK9, may represent an alternative approach to PCSK9 mAbs.

Incorrect. This medication does not exist.

Correct. By binding the bile acids, the drugsprevent the reabsorption of cholesterol into the blood. GI adverse effects (flatulence, constipation, dyspepsia, and nausea) are often present with these drugs, even at low doses, which limits their practical use.

Incorrect. Mipomersen is an antisense oligonucleotide able to bind the messengerRNA (mRNA) of ApoB-100, which triggers the selective degradation of mRNA molecules. Main concerns regarding mipomersen’s safety are related to liver toxicity and steatosis.

Incorrect. Fibrates are agonists of peroxisome proliferator-activated receptor(PPAR-a) with good efficacy in lowering fasting TG levels. Fibrates are generally well tolerated with mild adverse effects.

Incorrect. The administration of n-3 fatty acids appears to be safe and devoid ofclinically significant interactions.

Incorrect. SCORE2 and SCORE2-OP are intended for persons aged between40 and 89 years.

Correct. Known CVD constitutes a separate risk category and should be evaluated accordingly.

Correct. SCORE2 and SCORE2-OP are calibrated to four European risk regions,

Correct. SCORE2 and SCORE2-OP are not intended for those persons.

Incorrect. This level is not significant.

Incorrect. Risk from high Lp(a) increases slightly at levels of 30 mg/dL.

Correct. Lp(a) becomes clinically relevant above 50 mg/dL (105 nmol/L), with higher levels associated with a greater increase in CV risk.

Correct. The risk ofmajor CV events can increase by about 10 % at this level.

Incorrect. Diet does not significantly influence Lp(a) levels.

Incorrect. CV disease risk is increased in people with higher Lp(a) levels.

Correct. Lp(a) concentration is predominantly determined by genetics (>90%), more than any other lipoprotein, and levels vary with ethnicity.

Incorrect. Some medication can lower Lp(a) levels, usually not the other way around.

Correct. Statins are recommended as the first drug of choice to reduce CVD risk in high-risk patients.

Incorrect. This is not a first-line medication.

Incorrect. This is not a first-line medication. Currently available fibrates (gemfibrozil, fenofibrate, bezafibrate) have only moderate triglyceride-lowering effects.

Incorrect. This is not a first-line medication.

Correct. This group should be considered for FH.

Correct. This group should be considered for FH.

Correct. This group should be considered for FH.

Correct. This group should be considered for FH.

Incorrect. Treatment with statins is recommended for older people with ASCVD in the same way as for younger patients.

Incorrect. Treatment with statins is recommended for older people with ASCVD in the same way as for younger patients.

Correct. Treatment with statins is recommended for older people with ASCVD in the same way as for younger patients.

Correct. It is recommended that the statin is started at a low dose if there is significant renal impairment and/or the potential for druginteractions, and then titrated upwards to achieve LDL-C treatment goals.

Incorrect. Statins are not indicated in pregnancy.

Correct. Statins are not indicated in pregnancy.

Incorrect. Statin therapy is not recommended in premenopausal patients with diabetes who areconsidering pregnancy or are not usingadequate contraception.

Correct. Statin therapy is not recommended in premenopausal patients with diabetes who areconsidering pregnancy or are not usingadequate contraception.

Incorrect. In all ACS patients without any contraindication or definite history of intolerance, it is recommendedthat high-dose statin therapy isinitiated or continued as early as possible,regardless of initial LDL-C values.

Incorrect. In all ACS patients without any contraindication or definite history of intolerance, it is recommendedthat high-dose statin therapy isinitiated or continued as early as possible,regardless of initial LDL-C values.

Correct. In all ACS patients without any contraindication or definite history of intolerance, it is recommendedthat high-dose statin therapy isinitiated or continued as early as possible,regardless of initial LDL-C values.

Correct. Lipid levels should be re-evaluated 4 -6 weeks after ACS to determine whether a reduction of >50% from baseline and goal levels of LDL-C<1.4 mmol/L have beenachieved.

Incorrect. This is not recommended.

Correct. If the LDL-C goal is not achieved after 4 - 6 weeks with the maximally tolerated statindose, combination with ezetimibe isrecommended

Correct. If the LDL-C goal is not achieved after 4 - 6weeks despite maximal tolerated statin therapyand ezetimibe, the addition of a PCSK9inhibitor is recommended.

Incorrect. Haemodialysis is not the first-line choice in this situation.

Correct. Patients with a history of ischaemic stroke or TIA are at very high-risk of ASCVD, particularly recurrent ischaemic stroke, so it is recommended that they receive intensive LDL-C lowering therapy.

Incorrect. Initiation of lipid-lowering therapy is not recommended in patients with HF or aortic valvular stenosis in the absence of other indications for their use.

Correct. It is recommended that patients with moderate-to-severe chronic kidney disease. are considered to be at high or very high riskof ASCVD.

Correct. In patients with peripheral arterial disease, lipid-lowering therapy, including a maximum tolerated dose of statin, plus ezetimibe or a combination with a PCSK9 inhibitor if needed, is recommended to reduce the risk of ASCVD events.

Incorrect. Statin therapy is recommended for people in primary prevention aged ≥40 years with HIV, irrespective of estimated cardiovascular risk and LDL-C levels, to reduce the risk of cardiovascular events

Incorrect. Statin therapy is recommended for people in primary prevention aged ≥40 years with HIV, irrespective of estimated cardiovascular risk and LDL-C levels, to reduce the risk of cardiovascular events

Incorrect. Statin therapy is recommended for people in primary prevention aged ≥40 years with HIV, irrespective of estimated cardiovascular risk and LDL-C levels, to reduce the risk of cardiovascular events

Correct. Statin therapy is recommended for people in primary prevention aged ≥40 years with HIV, irrespective of estimated cardiovascular risk and LDL-C levels, to reduce the risk of cardiovascular events

Incorrect. While SCORE2 can guide the therapy, response to medication is highly individual.

Correct. The result of SCORE is stratification of patient into risk categories.

Correct. Based on risk categories, treatment goals are recommended.

Incorrect. Smoking is a risk factor that is filled in SCORE2 not the other way around.

Incorrect. Due to the probabilistic nature of SCORE2, is not possible to say the person has no CV risk.

Incorrect. SCORE2 divides persons even further.

Correct. These are the risk categories of SCORE2 system.

Incorrect. SCORE2 assesses the CV risk in 10 years horizon, it cannot predict imminent CV risk.

Correct. Documented ASCVD constitutes very high risk.

Incorrect. While type 2 DM is certainly a risk factor, just a DM diagnosis is not enough. Very high risk category is determined by DM with target organ damage (microalbuminuria, retinopathy, or neuropathy).

Correct. Severe CKD constitutes very high risk.

Incorrect. TC >8 mmol/L constitutes high risk.

Correct. Those are high risk factors for CV disease.

Correct. Those are high risk factors for CV disease.

Correct. Those are high risk factors for CV disease.

Correct. Those are high risk factors for CV disease.

Incorrect. Although 3 mmol/l is usually considered upper limit in general population, in very high risk patients, cutoff is stricter.

Incorrect. 2.6 is cutoff for high risk patients, not very high risk patients.

Correct. In primary prevention, pharmacological LDL-C-lowering therapy is recommended in persons at very high risk and LDL-C ≥1.8 mmol/L.

Incorrect. In primary prevention pharmacological LDL-C-lowering therapy should be considered (not recommended) in persons at very high risk and LDL-C ≥1.4 mmol/L.

Incorrect. Although 3 mmol/l is usually considered upper limit in general population, in high risk patients, cutoff is stricter.

Correct. In primary prevention, pharmacological LDL-C-lowering therapy is recommended in persons:at high risk and LDL-C ≥2.6 mmol/L.

Incorrect. In primary prevention, pharmacological LDL-C-lowering therapy should be considered (not recommended) in persons at high risk and LDL-C ≥1.8 mmol/L (70 mg/dL) but <2.6 mmol/L.

Incorrect. Pharmacological LDL-C-lowering therapy can be considered in this case but is not recommended as a rule.