An older man (71) with hypertension and a 25% 10-year ASCVD risk should be started on which statin intensity?

• A. No statin due to age
• B. Moderate-intensity statin
• C. Start low-intensity statin
• D. Start high-intensity statin

Answer: (D)

The key idea is using estimated 10-year ASCVD risk to guide statin intensity for primary prevention. When the predicted risk is high (around 20% or more), the benefit of intensive LDL lowering with a high‑intensity statin is substantial, helping to prevent heart attacks and strokes. In a 71-year-old man with hypertension and a 25% 10-year ASCVD risk, starting a high-intensity statin is appropriate because it maximizes the absolute risk reduction. This typically involves a potent statin at higher doses (for example, atorvastatin 40–80 mg or rosuvastatin 20–40 mg daily).

Starting a moderate- or low-intensity statin would yield less LDL lowering and less potential risk reduction, and choosing no statin would miss a clear preventive opportunity given his high estimated risk. Age alone isn’t a reason to avoid statins here; the high risk drives selecting a high-intensity regimen, assuming there are no contraindications.