Which medications address atherogenic dyslipidaemia beyond statins?

• A. Fibrates and niacin
• B. Omega-3 fatty acids and bile acid sequestrants
• C. Bile acid sequestrants and PCSK9 inhibitors
• D. Statins and ezetimibe

Answer: (A)

The key idea is how to manage atherogenic dyslipidaemia beyond simply lowering LDL with statins. This pattern includes high triglycerides, low HDL, and often small dense LDL. To address it, you want therapies that specifically modulate triglyceride-rich lipoproteins and HDL.

Fibrates work by activating PPAR-alpha, which increases lipoprotein lipase activity and decreases hepatic VLDL production. This lowers triglycerides and can modestly raise HDL, directly targeting the triglyceride-rich part of the dyslipidaemia.

Niacin reduces hepatic VLDL synthesis, which lowers triglycerides, and it also raises HDL. Together, these two classes address the TG/HDL abnormalities more directly than LDL-focused therapies.

Other options tend to focus mainly on lowering LDL (like bile acid sequestrants or PCSK9 inhibitors) or primarily reduce triglycerides without as strong an HDL effect (omega-3 fatty acids). That’s why fibrates and niacin are the best choice for addressing atherogenic dyslipidaemia beyond statins.