A 26-Year-Old Woman With High LDL Levels Since Her Teens
A 26–year-old woman has an LDL–C of 260 mg/dL, HDL–C of 51 mg/dL, and triglycerides of 102 mg/dL. She reports having elevated LDL–C levels of over 200 mg/dL since her teens and has tried various diets without success but has never taken a drug to lower her cholesterol. She is worried because her father died suddenly at age 38 and her father's brother had a myocardial infarction at age 32. Both were smokers. She is currently on a 2nd generation oral contraceptive and wonders if she should get off the contraceptive pill since she is engaged to be married in 6 months. She has an occasional cigarette and says that it is "social smoking." On exam, BP is 110/60 mm Hg and BMI is 24. She has bilateral inferior pole corneal arcus, no xanthelasma, and thickened Achilles tendons. Her cardiovascular examination is normal.
Which of the following is the best answer?