Which lipid lowering drug is paired with its correct mechanism of action?[Fill in the blank]

Question

BlackTom AI · Accepted Answer

Gemfibrozil increases lipoprotein lipase activity, so option d is correct.

1) Relevant knowledge points and concepts
- Fibrates (e.g., gemfibrozil) are PPAR-α agonists that upregulate lipoprotein lipase (LPL) and reduce hepatic VLDL production, lowering triglycerides and modestly raising HDL.
- Bile acid sequestrants (e.g., cholestyramine) bind bile acids in the gut and prevent their reabsorption, increasing bile acid excretion and forcing the liver to convert more cholesterol into bile acids.
- Statins (e.g., simvastatin) inhibit HMG-CoA reductase, decreasing hepatic cholesterol synthesis and upregulating LDL receptors on hepatocytes, which increases LDL clearance.
- PCSK9 inhibitors prevent PCSK9 from degrading LDL receptors, thereby increasing LDL receptor number and lowering LDL cholesterol.

2) Step-by-step evaluation of each option
- a. Cholestyramine; increased bile acid reabsorption: cholestyramine actually decreases bile acid reabsorption by binding them in the intestine — this statement reverses the mechanism and is incorrect.
- b. Simvastatin; decreased LDL receptors on liver cells: statins lower intracellular cholesterol and increase (not decrease) LDL receptor expression to clear more LDL — this option is wrong.
- c. PCSK9 inhibitor; increased LDL cholesterol: PCSK9 inhibitors increase LDL receptor availability and therefore decrease LDL cholesterol — this option is the opposite of the true effect.
- d. Gemfibrozil; increased lipoprotein lipase activity: fibrates activate PPAR-α leading to increased LPL expression/activity, promoting TG-rich lipoprotein catabolism — this correctly states the mechanism.

3) Calculations and intermediate steps
- No numeric calculations are required; mechanistic reasoning suffices. The intermediate logical steps: fibrate → PPAR-α activation → ↑ LPL expression/activity → ↑ TG catabolism → ↓ plasma triglycerides.

4) Why the correct answer is correct
- Gemfibrozil’s primary lipid-lowering action is mediated by activation of PPAR-α and resultant upregulation of LPL, which enhances clearance of triglyceride-rich lipoproteins. This matches the mechanism listed in option d.

5) Why other options are incorrect (brief)
- a reverses cholestyramine’s action, b contradicts statin biology (statins increase LDL receptors), c states the opposite effect of PCSK9 inhibitors.

Conclusion: The correct choice is d. Gemfibrozil; increased lipoprotein lipase activity, which matches the provided answer.

Which lipid lowering drug is paired with its correct mechanism of action?[Fill in the blank]Single choice

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