Case Study: Reducing Future ASCVD Risk Post-STEMI

Angio – CT scan of the postoperative condition of a 57 yearold male patient who has been treated for stenosis of the left anterior interventricular artery by an implantation of two contiguous stents (blue), axial section. (c) Sovereign

A 50-year-old man comes to your office after being admitted to the hospital with a ST-elevated myocardial infarction. He has hypertension and prediabetes. He states that 2 months previously he was seen in the emergency department because of chest pain, diaphoresis, and dyspnea that had begun 30 minutes after he tried to move some heavy boxes at work.

He was immediately taken to the catheterization laboratory where he underwent a percutaneous coronary intervention of the left anterior descending coronary artery with a drug-eluting stent. He was told that he had diffuse coronary artery disease and that his cholesterol level was very high.

The interventional cardiologist who treated the patient felt that he was at very high risk for future atherosclerotic cardiovascular events (ASCVD). Prior to hospital discharge, the patient was started on rosuvastatin 40 mg daily, in addition to ezetimibe, lisinopril, carvedilol, aspirin, and clopidogrel.

His blood pressure at the current visit is 140/84 mm Hg and his most recent lipid panel shows a low-density lipoprotein level of 200 mg/dL and high-density lipoprotein level of 32 mg/dL. H is compliant with his medical therapy and wants to know how to best reduce his future risk of having a myocardial infarction.

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