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Statin or Not?

Apr 15, 2017

A 23-year-old athletic, nonobese man presents with a low-density lipoprotein cholesterol (LDL-C) level of 196. He reports that he's recently been eating more "bar food." Both his parents have high cholesterol, and his father had a myocardial infarction at age 41 y. His physical exam is notable for bilateral corneal arcus and Achilles tendon xanthomas. What's the best treatment option?


Correct answer is D. Treat with diet + exercise + high-intensity statin

Explanation: Our patient's presentation is consistent with familial hypercholesterolemia (FH). Per the 2013 American College of Cardiology/American Heart Association guidelines, patients ?21 y old should begin statin therapy as soon as they're diagnosed with FH. Evidence shows that each 39-mg/dL reduction in LDL-C with statin therapy reduces atherosclerotic cardiovascular disease (ASCVD) risk by ~20%. Patients with LDL-C levels ?190 mg/dL require even more substantial reductions, along with intensive management of additional ASCVD risk factors. Using high-intensity statin therapy to achieve at least a 50% reduction is reasonable, along with diet, exercise, and the addition of a nonstatin (cholesterol-lowering) medication if needed.

Stone NJ, et al. J Am Coll Cardiol. 2014;63(25):2889-2934.