A 50-year-old man with hypertension and a QRISK3 of 15% started Atorvastatin 20 mg three months ago. His baseline LDL was 4.2 mmol/L. What is the most appropriate next step?

A 50-year-old man with hypertension and a QRISK3 of 15% started Atorvastatin 20 mg three months ago. His baseline LDL was 4.2 mmol/L. What is the most appropriate next step?

• A. Repeat lipid profile in 3 months
• B. Increase statin dose now
• C. Add ezetimibe
• D. Warfarin

Answer: (C)

Starting a statin and then reassessing lipid levels after a few months is how we judge response. Here, atorvastatin 20 mg (a moderate‑intensity statin) is expected to lower LDL by a meaningful amount, but if the LDL remains above the target for primary prevention, the next step is to add a non-statin agent to achieve further reduction. Ezetimibe works by blocking intestinal cholesterol absorption, giving an additional ~15–20% drop in LDL when added to statin therapy, without the higher risk of adverse effects that might come with increasing the statin dose. This combination helps reach a greater LDL reduction and further lower cardiovascular risk. Warfarin isn’t used for lipid lowering.

Starting a statin and then reassessing lipid levels after a few months is how we judge response. Here, atorvastatin 20 mg (a moderate‑intensity statin) is expected to lower LDL by a meaningful amount, but if the LDL remains above the target for primary prevention, the next step is to add a non-statin agent to achieve further reduction. Ezetimibe works by blocking intestinal cholesterol absorption, giving an additional ~15–20% drop in LDL when added to statin therapy, without the higher risk of adverse effects that might come with increasing the statin dose. This combination helps reach a greater LDL reduction and further lower cardiovascular risk. Warfarin isn’t used for lipid lowering.