USMLE Step 2 - Question 15

A 44 year old male with no significant past medical history presents to his primary care physcician for a routine physical examination. He has no physical complaints. His blood pressure is 115/85, heart rate 80, respirations 12, and he is afebrile. His physical examination reveals normal lung sounds and normal heart sounds. His ECG is normal. Laboratory studies reveal an total cholesterol of 220 mg/dL, LDL 145 mg/dL, HDL 40 mg/dL, and triglycerides of 145 mg/dL. What is the most appropriate treatment?

A. Diet/lifestyle modifications

B. Diet/lifestyle modifications and a HMG-CoA reductase inhibitor

C. Diet/lifestyle modifications, a HMG-CoA reductase inhibitor and niacin

D. No therapy needed

According to the ATP III guidelines for LDL management, a person with 0-1 risk factors for coronary artery disease (see below) should have an LDL of less than 160 mg/dL. If the LDL is between 160-190, then diet/lifestyle modifications should be initiated. If the LDL is > 190, then medications (HMG-CoA reductase inhibitor or "statin") should be started. Coronary heart disease risks factors include tobacco use, hypertension, low HDL levels, a family history of premature heart disease (male < 55 years old or female < 65 years old), and age (men > 45 and women > 55). An HDL cholesterol of > 60 mg/dL counds as a negative risk factor (cancels out 1 risk factor).