Dr. Heuser is interested to hear what your approach would be with the following patient. Please comment below with your thoughts.
You see a 50 year old gentleman with 3 vessel coronary disease. This non-diabetic, non-smoker really takes care of himself, but in spite of great effort cannot tolerate any statin. Even at normal weight, his LDL still is persistently over 150. His 30%-40% lesions are not severe enough for PCI or surgery, however 10 years ago, you stented his LAD lesion which continues to be patent. His FFR is non-significant in any of these lesions, but more importantly, what can you give him to reduce his risk for cardiovascular disease progression?
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I would try low dose pitavastatin 3 x a wk. w zetia 10 mg a day. Co q 10 daily. Attempt to titrate from there. Thx.