A 62-year-old man recently discharged after a myocardial infarction has total cholesterol 6.2 mmol/L and LDL 4.1 mmol/L; he is on clopidogrel, aspirin, bisoprolol and lisinopril. What is the most appropriate lipid-lowering treatment?

• A. Simvastatin
• B. Pravastatin
• C. Rosuvastatin
• D. Atorvastatin 80 mg once daily

Answer: (D)

After a myocardial infarction, the goal is to aggressively lower LDL cholesterol to reduce the risk of another event. This is achieved with high-intensity statin therapy, which aims for about a 50% or greater reduction in LDL.

Among the options, starting atorvastatin at 80 mg once daily is the strongest, most established high-intensity statin regimen. It routinely lowers LDL by roughly 50–60% in many patients, making it the most reliable way to achieve the substantial lipid lowering needed for secondary prevention in someone with a recent MI and an LDL of 4.1 mmol/L.

The other statins listed are either less potent at common doses (pravastatin, simvastatin) or, while potent, would not beat the clear, standard choice for maximizing risk reduction in this post-MI setting. Rosuvastatin is also a high-intensity option, but the given answer reflects using the strongest, widely used regimen first. Initiate this therapy with monitoring for potential adverse effects and interactions, and adjust if needed based on tolerance and response.