RT Book, Section
A1 Malloy, Mary J.
A1 Kane, John P.
A2 Katzung, Bertram G.
A2 Vanderah, Todd W.
SR Print(0)
ID 1176974584
T1 Agents Used in Dyslipidemia
T2 Basic & Clinical Pharmacology, 15e
YR 2021
FD 2021
PB McGraw-Hill
PP New York, NY
SN 9781260452310
LK accessmedicine.mhmedical.com/content.aspx?aid=1176974584
RD 2024/04/25
AB CASE  STUDYA  36-year-old  man  has  an  LDL-cholesterol  of  190  mg/dL,  normal  triglycerides  and  HDL.  His  lipoprotein  (a)  is  four  times  normal.  His  coronary  calcium  score  was  appropriate  for  a  man  of  60  years.  He  has  no  symptoms  of  coronary  or  peripheral  vascular  disease.  Physical  exam  was  normal  except  for  a  systolic  aortic  valve  murmur.  His  mother  had  a  myocardial  infarction  at  age  51  and  had  no  known  risk  factors  other  than  an  elevated  cholesterol.  He  developed  muscle  symptoms  with  each  of  3  statins  (atorvastatin,  rosuvastatin,  and  simvastatin)  but  levels  of  creatine  kinase  remained  normal.  On  genetic  analysis  he  was  heterozygous  for  the  SLCO1B1  mutation  associated  with  statin  myopathy,  and  for  a  loss  of  function  mutation  in  the  gene  for  the  LDL  receptor.  His  LDL-C  goal  is  in  the  40  to  50-mg/dL  range  because  of  his  two  lipoprotein  risk  factors,  his  coronary  artery  calcification,  and  his  mother’s  history  of  premature  coronary  artery  disease.  He  has  no  other  risk  factors  and  his  diet  and  exercise  habits  are  excellent.  How  would  you  manage  this  patient?