Case studies

The patient requests statin therapy for cholesterol: a challenging case history

Leon A Simons



Patients with moderately elevated LDL cholesterol levels but low cardiovascular risk are often best managed with diet and lifestyle advice and reassurance.

Key Points

  • Assessment of cardiovascular risk is a routine part of GP care.
  • Diet remains a cornerstone of therapy and statin drugs should be reserved for those patients at high risk.
  • In middle-aged patients without prior cardiovascular disease, it is helpful to perform a calculation of five-year absolute risk.
  • Absolute risk exceeding 10 to 15% is generally taken as a threshold indicating a need for statin therapy.
  • Statin drugs may occasionally cause myalgia and mood changes or other CNS symptoms. These problems are best managed by cessation of drug and awaiting resolution over the next few weeks. Other statins may be tried later in high-risk cases (e.g. pravastatin or very low-dose rosuvastatin).