Controversies in the Use of Statins: Managing Patients with Normal Lipid Profi les, Elevated hs-CRP

A 55-year-old white male presents for cardiology consultation to discuss options for reducing his cardiovascular risk (Fig. 1). He has a family history of ischemic heart disease—his father underwent coronary bypass surgery at age 70—and no other cardiac risk factors. Fasting lab results, which were obtained by his primary care physician, show a normal lipid profi le, but his high sensitivity Creactive protein (hs-CRP) level is elevated. He is asymptomatic and had a normal treadmill exercise test in the past month. In addition to lifestyle modifi cation, such as diet, exercise, weight loss and risk factor control, is there a role for pharmacologic intervention for primary prevention of coronary artery disease (CAD) in this patient? Should any additional cardiac evaluation be considered to screen for subclinical atherosclerosis?