1. Which of the following patients is most likely to benefit from statin therapy?
1. A 12 years old boy with bilateral enlarged tonsils and yellow colored speckles in his pharynx, with a serum HDL of 8 mg/dL and a serum LDL of 122 mg/dL. The boy has premature coronary artery disease.
2. A 65 years old, healthy man who has a serum LDL of 122 mg/dL.
3. A 42 years old lady admitted for treatment of ischemic stroke who was found to have anti-nuclear anti bodies positive.
4. A 73 years old lady who has chronic stable angina and a serum LDL level of 122 mg/dL.

Answer: The first clinical scenario describes a boy with Tangier’s disease and there is no role for statin therapy in this condition. The 65 years old healthy man with raised LDL requires aggressive diet and exercise to lower his lipids. The 73 years old woman however has chronic coronary artery disease and will benefit immensely from statin therapy. Therefore the same LDL value of 122mg/dL would warrant aggressive treatment in a coronary disease or a risk equivalent patient while only life style modification in a healthy individual.