Patients 75 and younger with cardiovascular disease should be treated with which therapy?

• A. Beta-blocker
• B. ACE inhibitor
• C. High-intensity statin
• D. Low-dose aspirin

Answer: (C)

Aggressively lowering LDL cholesterol with high-intensity statin therapy is the standard for secondary prevention in patients 75 and younger with established cardiovascular disease. This approach yields the greatest relative risk reduction for recurrent myocardial infarction, stroke, and cardiovascular death by typically lowering LDL-C by at least 50%. Examples include regimens like atorvastatin 40–80 mg or rosuvastatin 20–40 mg daily. While beta-blockers and ACE inhibitors have important roles in specific scenarios (such as after MI with reduced LV function or in hypertension), they don’t provide the same broad, long-term impact on recurrent ASCVD events across this age group as high-intensity statin therapy. Low-dose aspirin can be beneficial for secondary prevention but carries bleeding risk and isn’t the universal central choice; when selecting a single cornerstone therapy for this category, a high-intensity statin is the strongest option.