A57-year-old man comes to see you for follow-up 4 weeks after being discharged from hospital for unstable angina. His coronary angiogram showed moderate nonstenotic disease in two vessels. The cardiologist asks you to follow up on his fasting lipid profile since it was not checked in the hospital. His T-chol is 240 mg/dL, LDL 120 mg/dL, HDL 50 mg/dL, and triglycerides 130 mg/dL.For the above patient with dyslipidemia, select the most appropriate treatment.
For patients with established CAD, their future risk for further cardiovascular events is high (10-year risk >2 0%). In such individuals, the goals of LDL level are adjusted lower to match the increased risk. For secondary prevention, the LDL level target is < 100 mg/dL. For all individuals at increased risk, lifestyle modification is stressed as a key component therapy. In this patient, given the recent diagnosis of CAD and the elevated LDL level, treatment with a "statin" is also indicated.
fibric acid derivatives (clofibrate, gemfibrozil)
nicotinic acid
bile acid-binding resins (cholestyramine, colestipol)
hepatic hydroxymethylglutaryl coenzyme A (HMG-Co) reductase inhibitors (lovastatin, simvastatin, pravastatin)
C.V.S.