Fifty-Five-Year-Old Male Presents With a Complicated History
The patient is a non-smoker, eats a diet that is low in fats and carbohydrates and exercises often. He weighs 193 pounds, stands six feet tall, has a body mass index of 26.5 and a 38-inch waist circumference. His father died at the age of 50 from a myocardial infarction while his mother is 75 years old and has type 2 diabetes.
Currently, he is on 81 mg of aspirin daily as well as 20 mg simvastatin daily. Some notable lipid panel results revealed that his total cholesterol was 170 mg/dL with his LDL particle number being 1407 nmol/L.
Other labs showed that his liver enzymes were elevated. In addition, the patient's kidney function tests demonstrated creatinine clearance that is impaired, as well as elevated uric acid and blood urea nitrogen.
A computed tomography angiography revealed that the patient has calcium in his arteries including soft plaque in the left anterior descending. In addition, he has remarkable coronary calcium.
What would be your treatment plan for this patient?