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Cardiology - Preventive Cardiology
A 48-year-old man presented to the cardiology outpatient clinic for lipid management 6 weeks after a non-ST-elevation myocardial infarction (NSTEMI) treated with percutaneous coronary intervention (PCI). His medical history included hypertension, obesity (body mass index 31.2 kg/m²), and a 20-pack-year smoking history. His father had experienced a myocardial infarction at 52 years of age. The patient had recently stopped smoking and adopted dietary modifications. On examination, blood pressure was 128/78 mmHg and heart rate was 72 beats/min. Laboratory investigations showed low-density lipoprotein cholesterol (LDL-C) 118 mg/dL, triglycerides 198 mg/dL, high-density lipoprotein cholesterol (HDL-C) 39 mg/dL, glycated hemoglobin (HbA1c) 5.8%, and normal renal and liver function. Current medications included rosuvastatin 20 mg once daily, aspirin 75 mg once daily, ticagrelor 90 mg twice daily, ramipril 5 mg once daily, and bisoprolol 5 mg once daily. Despite adherence to lifestyle measures and high-intensity statin therapy, his LDL-C remained above the recommended target for patients at very high cardiovascular risk. Further optimization of lipid-lowering therapy was therefore considered.
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