The correct answer is: 3. The patient does not need any further treatment as he exercises routinely and remains asymptomatic.

HsCRP has been well established as a prognostic marker for inflammation underlying atherothrombosis, predicting future cardiovascular events. It has been shown to be potentially useful as a therapeutic target in a sub-study of PROVE IT -TIMI22 Trial, revealing benefit from achieving lower hsCRP levels from statin therapy in patients with acute coronary syndrome and this effect seems to be independent of LDL levels. The JUPITER Trial tested the hypothesis that a high dose statin could reduce future cardiovascular events in asymptomatic individuals, men >50 years of age and women 60 years of age, with elevated hsCRP>2 mg/l who had a baseline LDL < 130 mg/dl. Treatment with Rousvastatin was associated with a highly significant reduction in cardiovascular end points, along with individual primary end points at the end of two years in this trial. The relative hazard reduction was similar irrespective of sex, ethnicity and Framingham risk score. Recently published ACC/AHA Blood Cholesterol management guidelines recommends that asymptomatic, non-diabetic individuals in the age group 40-75 years, with LDL cholesterol 70-189mg/dl with a 10 year risk of >7.5% (http://my.americanheart.org/cvriskcalculator) should be initiated on statin therapy. In our index patient, the 10-year atherosclerotic cardiovascular risk is 10.1% and lifetime risk is 46% and hence mandates discussion and initiation of statin therapy.