1. Case 1: A 73-year-old white female with carotid disease
Content Points:
In that this patient has documented atherosclerotic vascular disease, discussion should focus on prevention of future carotid or coronary events. A patient like this one carries a fivefold to sevenfold elevated risk for developing new or recurrent coronary heart disease.30
Treatment goals for lipids should be addressed, with emphasis on meeting NCEP guidelines for LDL-C. Hence the goal in this case is to decrease LDL-C to less than 100 mg/dL.
Immediate institution of nonpharmaceutical therapy is warranted, and cholesterol-lowering drug therapy is often needed.25
The patient’s age should also be discussed for its relevance to the question of initiating drug therapy. In the recent primary prevention West of Scotland Coronary Prevention Study, treatment with a statin provided the same benefit in patients over age 60 as under age 60.22, 31

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6. Case 2: A 48-year-old white male with angina
Content Points:
The major issues for this patient are the obvious presence of coronary risk factors, the potential for reducing morbidity and mortality, and the opportunities to reduce risk through nonpharmacologic and pharmacologic therapies.
The patient’s diet postangioplasty still leaves lipid levels which require pharmacologic attention. For instance, according to current guidelines, the goal of therapy in patients with clinical coronary heart disease is to decrease LDL-C to less than 100 mg/dL.
An interesting finding from the West of Scotland Coronary Prevention Study Group (WOSCOPS) is that the “absolute benefit of [statin] therapy was greatest in subjects with the highest baseline risk.”22, 31
WOSCOPS clearly demonstrated the benefits of statin therapy in the prevention of coronary heart disease events in middle-aged hypercholesterolemic men without prior myocardial infarction.

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13. Case 3: A 38-year-old white male with a family history of coronary artery disease
Content Points:
This patient demonstrates what is often a clinical dilemma for the practicing physician ... a patient with no clinical coronary disease, yet presenting with lipid levels and a family history placing him at potential risk.
The AHA Step 2 diet this patient is following seems to be helping lower the LDL-C. However, other lipid levels remain below reference values. With the HDL-C of 31 mg/dL, triglycerides at 250 mg/dL, and total cholesterol at 230 mg/dL, there are opportunities remaining for dietary manipulation and, if necessary, use of pharmacotherapy.
The “high-normal” blood pressure in this patient should also be a point of attention in follow-up visits.

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