**Question:** A 58-year-old woman is admitted to hospital with left-sided hemiparesis. She is diagnosed with an ischemic right cortical stroke, and started on amino salicylic acid (ASA) for secondary prevention. Her carotid ultrasound reveals no arterial stenosis. She has no other significant past medical history but she does smoke half pack a day. Her fasting lipid profile is T-chol 240 mg/dL, HDL 50 mg/dL, LDL 160 mg/dL, and triglycerides 130 mg/dL. For the above patient with dyslipidemia, select the most appropriate treatment.

A. Statins
B. Fibrates
C. Bile acid sequestrants
D. Ezetimibe

**Correct Answer:** D. Ezetimibe

**Core Concept:** Dyslipidemia is a condition characterized by abnormal lipid levels in the blood, leading to an increased risk of cardiovascular diseases. In this case, the patient has high total cholesterol (T-chol) (240 mg/dL), low high-density lipoprotein cholesterol (HDL) (50 mg/dL), high low-density lipoprotein cholesterol (LDL) (160 mg/dL), and elevated triglycerides (130 mg/dL).

**Why the Correct Answer is Right:** Among the available options, ezetimibe is the most suitable treatment for this patient. Ezetimibe is a cholesterol absorption inhibitor that works by blocking the reabsorption of bile acids in the intestine, thereby reducing cholesterol absorption and increasing fecal cholesterol excretion. As a result of ezetimibe therapy, LDL levels will decrease, which is crucial for this patient with high LDL levels (160 mg/dL) and a history of cardiovascular disease (ischemic stroke).

**Why Other Options are Incorrect:**

A. Statins: Statins are a class of drugs that inhibit HMG-CoA reductase, responsible for cholesterol synthesis. Statins are typically recommended for patients with primary hyperlipidemia or those with established cardiovascular disease. In this case, the patient already has a history of cardiovascular disease (ischemic stroke), but her lipid profile indicates primary hyperlipidemia (high LDL, low HDL). Therefore, statins would not be the ideal choice for her.

B. Fibrates: Fibrates are peroxisome proliferator-activated receptor alpha (PPAR-alpha) agonists used to lower triglycerides and raise HDL levels. While her triglycerides are elevated (130 mg/dL), her main concern is high LDL levels (160 mg/dL), which is why ezetimibe is the correct choice.

C. Bile acid sequestrants: Bile acid sequestrants are used to lower cholesterol levels, specifically LDL. However, the patient's main concern is her high LDL level (160 mg/dL), making ezetimibe a more suitable option.

**Clinical Pearl:**

Ezetimibe is a valuable therapeutic option for patients with established cardiovascular disease and

✓ Correct Answer: D. hepatic hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (lovastatin, simvastatin, pravastatin)