ABSTRACT
This chapter presents a case study of a 64-year-old black woman, who was born in September 1953 and known to have systemic hypertension (being treated with hydrochlorothiazide), was otherwise well until April 2018 when, while driving to work, she experienced substernal chest pain that radiated to her left arm, prompting her to visit an emergency room. A similar pain had occurred periodically during each of the 3 previous days. The report demonstrates the deficiency of present-day lipid-lowering drug guidelines and emphasizes the need to switch emphasis from decreasing risk of an atherosclerotic event to the prevention of arterial plaques, a goal which will require a much lower threshold of low-density lipoprotein cholesterol to initiate drug therapy. The hitherto described patient presented with unstable angina pectoris, her first atherosclerotic event, and both angiography and endarterectomy disclosed extreme coronary narrowing.
