Statin Therapy in Older Adults with Reduced Life-Expectancy
AB, an 87-year old male with history of coronary artery disease (CAD) s/p MI s/p PCI, hypertension, end-stage renal disease (ESRD) on dialysis and heart failure reduced ejection fraction (HFREF) presents for evaluation and discussion about "turning off" his implantable cardioverter-defibrillator (ICD). When questioned, he states he has "had enough" and is "ready to go to the next life". He reports that his physical condition has declined so much in the past year, and he has a very poor quality of life. He states that he experiences shortness of breath, dyspnea on exertion, and muscle pain. Moreover, he also reports frequent hospitalizations. After speaking with his nephrologist, he recently made the decision to discontinue hemodialysis and reduce his burden of medications.
Past medical history:
Acute myocardial infarction, stent to left anterior descending (LAD) in 2010
End stage renal disease
Heart failure reduced ejection fraction (EF <20%, ICD as of 2017)
Atorvastatin 40 mg PO daily
Carvedilol 25 mg PO bid
Furosemide 80 mg PO daily
Lipid panel from last week (all in mg/dL); total cholesterol 170, HDL-C 40, triglycerides 100, LDL-C 110
According to the 2018 ACC/AHA cholesterol guidelines, which ONE of the following is the best option for his lipid lowering therapy at this time?