A 50-year-old man with history of CAD/AMI and hypertension should be treated with which statin regimen?

• A. Moderate-intensity statin
• B. No statin due to ASCVD history
• C. High-intensity statin based on ASCVD history alone
• D. Moderate-intensity statin with BP control

Answer: (C)

The key idea is that established ASCVD calls for high-intensity statin therapy to aggressively lower LDL-C and reduce the risk of recurrent events. For a patient with CAD/AMI, the recommended approach is a high-intensity statin such as atorvastatin 40–80 mg daily or rosuvastatin 20–40 mg daily, aiming for about a 50% or greater reduction in LDL-C (often to very low levels, commonly <70 mg/dL in high-risk patients). This targets the strongest evidence-based strategy for secondary prevention.

Moderate-intensity statin would still help, but it doesn’t meet the intensity shown to provide the greatest benefit in someone with established ASCVD. Not treating with statins at all ignores substantial proven risk reduction. A regimen that emphasizes BP control without achieving the higher LDL-C–lowering goal from a high-intensity statin underestimates the lipid management needed for this patient.