The Role of Non-statin Therapy for Secondary Prevention of ASCVD

Clinical Case

Xiaoming Jia, MD; Salim S. Virani, MD, PhD, FACC; Reviewer: Jay H. Shubrook, DO


November 15, 2019

Editorial Collaboration

Medscape &

Case Presentation

A 64-year-old woman sees her cardiologist for a routine follow-up visit after a second myocardial infarction (MI).

The patient's past medical history is significant for two MIs, the first of which occurred when she was 55 years old and required two stents to the left anterior descending artery. The second MI occurred 5 months ago and required one stent to the right coronary artery. The patient's medical history is also remarkable for type 2 diabetes mellitus (DM), hypertension, and chronic kidney disease (CKD).

She has no known food, drug, or environmental allergies and denies past or current tobacco use or alcohol consumption.

The patient's current medications include:

  • Rosuvastatin 40 mg once daily (increased from 10 mg following the second MI)

  • Aspirin 81 mg once daily

  • Ticagrelor 90 mg twice daily

  • Metformin 1 g twice daily

  • Semaglutide 0.5 mg subcutaneously (SC) once weekly

  • Lisinopril 5 mg once daily

The patient's vital signs, weight, and body mass index (BMI) at presentation are:

  • Blood pressure, 126/84 mm Hg

  • Heart rate, 79 beats/min

  • Respiratory rate, 18 breaths/min

  • Temperature, 98.2ºF

  • Weight, 83 kg

  • BMI, 28.1 kg/m2 (25 to < 30 kg/m2 = overweight)

Laboratory studies performed in advance of this follow-up visit disclosed these values:

  • Total cholesterol, 165 mg/dL

  • Triglycerides (TGs), 135 mg/dL

  • High-density lipoprotein cholesterol (HDL-C), 52 mg/dL

  • Low-density lipoprotein cholesterol (LDL-C), 86 mg/dL

  • Non-HDL-C 113 mg/dL

  • Fasting glucose, 108 mg/dL

  • A1c, 6.2%

  • Estimated glomerular fraction rate, 52 mL/min/1.73 m2

  • Urine albumin-to-creatinine ratio, 47 mg/g

During the follow-up visit, the patient reports that she has been taking all medications as prescribed since the last coronary event. (This stated adherence is consistent with a review of her prescription refill records.) She also notes having made improvements to her lifestyle through dietary modifications and increased exercise and physical activity. Despite these interventions, she is still concerned about having future MIs and asks the cardiologist if there are any additional measures available to further reduce her risk.