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Sixty-One-Year-Old Male with Family History of Myocardial Disease

A 61-year-old male desired a thorough exam and preventative treatment given his familial history. When he was 50, the patient's father died of myocardial infarction. The patient himself denies being a smoker, drinker or user of illicit substances. He exercises frequently and follows a diet that is low in both fats and carbohydrates.

Standing at six feet, the patient weighs in at 195 pounds. His total cholesterol is 170 mg/dL with his LDL particle number being elevated at 1,407 nmol/L (less than 1,000 nmol/L is desired).

His left anterior descending artery revealed significant calcium and soft plaque with his other arteries showing calcium. Currently, he is taking 81 mg aspirin daily and 20 mg simvastatin.

How would you treat this patient? Why would you choose that particular treatment?