A 62-year-old patient has a 10-year risk of cardiovascular disease of 14%. Their GP wishes to prescribe a lipid lowering medication for primary prevention. Which of the following would be the MOST appropriate treatment?

• A. Simvastatin 40 mg OD
• B. Rosuvastatin 5 mg OD
• C. Atorvastatin 20 mg OD
• D. Pravastatin 40 mg OD

Answer: (C)

For primary prevention, prescribing a statin is guided by the patient's 10-year cardiovascular risk and choosing a dose that provides a meaningful LDL-C lowering while balancing safety. A 62-year-old with a 14% 10-year risk falls into a moderate-risk category, where moderate-intensity statin therapy is typical to reduce future cardiovascular events.

Among the options, starting a moderate-intensity statin that reliably lowers LDL-C by roughly 30–50% is ideal. Atorvastatin 20 mg daily fits this profile well and has strong, consistent evidence for reducing ASCVD events in primary prevention. It offers a robust LDL-C reduction without stepping into the higher-dose risks seen with some other regimens. The other choices vary in potency or dosing: a low-dose rosuvastatin may not achieve the desired LDL-C reduction; simvastatin 40 mg is potent but has more safety and drug-interaction considerations; pravastatin 40 mg is effective but generally provides a smaller LDL-C reduction than atorvastatin 20 mg.

So, atorvastatin 20 mg once daily is the most appropriate starting option in this scenario.