ASCVD Risk Reduction in a Patient with Familial Hypercholesterolemia
A 39-year-old female presents to the clinic for a follow-up management of hypercholesterolemia.
Past medical history: type 2 diabetes, hypertension
- No known history of heart disease
Mother living with suspected Heterozygous Familial Hypercholesterolemia (not confirmed with genetic testing), myocardial infarction at 43
Father living with type 2 diabetes
Atorvastatin 80 mg by mouth daily
Ezetimibe 10 mg by mouth daily
Metformin 500 mg by mouth twice daily
Lisinopril 20 mg by mouth daily
Hydrochlorothiazide 12.5 mg by mouth daily
No visible signs of xanthomas, tendon xanthomas, xanthelasmas, or corneal arcus
BP: 119/77 mm Hg HR: 75 bpm Weight: 64 kg BMI: 24 kg/m2
A1c: 6.1%, TSH: 3.3 mIU/L, Scr: 0.9 mg/dL, GFR: >60 mL/min/1.73 m2, P:C: 0.1 mg/mg, albumin: 4g/dL AST: 30 U/L ALT: 25 U/L, Alk Phos: 90 U/L, Billirubin:0.5mg/dL
|9 months ago||370||304||50||320||79||not calculated, since the patient has severe hypercholesterolemia (LDL-C ≥190 mg/dL) at baseline|
The patient reports good adherence to medical therapy and appropriate lifestyle habits.
During today's visit, the patient's labs were assessed, and secondary causes of hypercholesterolemia were ruled out. The patient's Dutch Lipid Score is 6 points (probable FH) and there is concern for residual cardiovascular risk. She is willing to take additional therapy to lower her LDL-C and ASCVD risk.
To reduce her residual cardiovascular risk, which of the following choices is most appropriate based on the ACC/AHA Guidelines?