A 62-year-old man with coronary artery disease with a single coronary stent from 10 years ago presents for follow-up. His other medical history includes former smoking and hypertension, which is currently well managed. He is taking atorvastatin 80 mg daily for lipid lowering.
His fasting lipid panel values include total cholesterol level 127 mg/dL, triglyceride (TG) level 210 mg/dL, HDL-C level 45 mg/dL, and LDL-C level 68 mg/dL.
The correct answer is: E. A and C.
For adults with persistently elevated TG levels (≥150 mg/dL) after evaluation and management of secondary causes, the 2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia recommends lifestyle management that includes a diet consisting of low added sugars, reduced alcohol intake, reduced saturated fat intake, and routine exercise. Furthermore, in patients with ASCVD such as this one, the guideline recommendation for LDL-C levels ≥55 mg/dL or non–HDL-C levels ≥85 mg/dL is intensification of LDL-C lowering therapy. Because he was already taking the maximum dose of a high-intensity statin, ezetimibe would be added next for additional LDL-C lowering.
Genetic testing may be considered to aid in the diagnosis of familial chylomicronemia syndrome (FCS) when TG levels are ≥880 mg/dL and frequently ≥1000 mg/dL. Apolipoprotein C3 (APOC3) inhibitors include olezarsen (approved for severe hypertriglyceridemia [TG levels ≥500 mg/dL] and FCS) and plozasiran (approved for FCS; not indicated for patients with moderate hypertriglyceridemia).
This patient case quiz is part of the larger Hypertriglyceridemia (HTG) and Cardiovascular (CV) Health: Recognizing Risks and Tackling Management initiative, supported by Ionis Pharmaceuticals. To visit the HTG and CV Health grant page and access additional educational activities on this topic, click here.
References
- Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of dyslipidemia: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2026;87(19):2624-2757. doi:10.1016/j.jacc.2025.11.016
- Saadatagah S, Larouche M, Naderian M, et al. Recognition and management of persistent chylomicronemia: a joint expert clinical consensus by the National Lipid Association and the American Society for Preventive Cardiology. J Clin Lipidol. 2025;19(4):723-736. doi:10.1016/j.jacl.2025.03.012
