Stone NJ et al: 2013 ACC/AHA guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. A report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation 2014; 129 (25 Suppl 2):S1. Erratum: Circulation 2015;132:e396.
Swiger JK et al: Statins and cognition: A systematic review and meta-analysis of short and long term cognitive effects. Mayo Clin Proceed 2013;88:1213.
Tsujita K et al: Impact of dual-lipid lowering with ezetimibe and atorvastatin on coronary plaque regression in patients with percutaneous coronary intervention. The randomized controlled PRECISE-IVUS trial. J Am Coll Cardiol 2015;66:495.
Yahya R et al: Lomitapide effects HDL composition and function. Atherosclerosis 2016;251:15.
Zimmer S et al: Cyclodextrin promotes atherosclerosis regression via macrophage reprogramming. Sci Transl Med 2016;8:333ra50.
The patient’s history of muscle symptoms should be care-fully evaluated. The genotype at the SLCO1B1 locus might be obtained to determine whether myositis is due to impaired metabolism of statins. If you agree that her muscle symptoms were clearly associated with statin use but were not particu-larly severe and not associated with creatine kinase elevations significantly greater than normal, you could prescribe any one the agents she tried in the past or select a different statin. The starting dose should be low and the drug given on alter-nate days, increasing the dose and frequency to achieve the LDL-C goal. If this is not tolerated or the goal is not reached, alternate drugs can be used, including a bile acid binding resin, intestinal sterol absorption inhibitor, or niacin (monitoring uric acid, glucose, and liver enzymes). These can be used in combinations with each other or with a low dose statin. If all else fails, use of a PCSK9 monoclonal antibody should be con-sidered. Her homocysteine level should be measured because of the synergy between that amino acid and Lp(a) with respect to thrombotic risk. Also, because of her elevated Lp(a), she should be evaluated for aortic stenosis.
Nonsteroidal Anti-Inflammatory Drugs, Disease-Modifying Antirheumatic Drugs, Nonopioid Analgesics, & Drugs Used in Gout
Ahmed A. Negm, MD, & Daniel E. Furst, MD twice daily. His symptoms are reduced at this dosage, but he com-plains of significant heartburn that is not controlled by antacids. He is then switched to celecoxib, 200 mg twice daily, and on this regimen his joint symptoms and heartburn resolve. Two years later, he returns with increased joint symptoms. His hands, wrists, elbows, feet, and knees are all now involved and appear swollen, warm, and tender. What therapeutic options should be considered at this time? What are the possible complications? A 48-year-old man presents with complaints of bilateral morning stiffness in his wrists and knees and pain in these joints on exercise. On physical examination, the joints are slightly swollen. The rest of the examination is unremarkable. His laboratory findings are also negative except for slight anemia, elevated erythrocyte sedi-mentation rate, and positive rheumatoid factor. With the diagnosis of rheumatoid arthritis, he is started on a regimen of naproxen, 220 mg twice daily. After 1 week, the dosage is increased to 440 mg