could try a stronger statin such as atorvastatin, again titrating upwards.

On commencing statins, patients should be advised to report unexplained myalgia or muscle weakness. Statin-induced myositis is not common but can be a serious problem if the drug is not withdrawn. However, mild muscle aches without evidence of myositis are much commoner and are not necessarily an indication for statin withdrawal.

Fibrates are appropriate drugs for those intolerant of statins, but can also cause myopathy. They can also be used as second line in those not achieving control with statins alone or if fasting triglycerides remain raised above 2.3 mmol/l despite statin therapy. In patients with previous myocardial infarction, omega-3 fatty acids have been shown to reduce CVD and all-cause mortality. They may also be used if hypertriglyceridaemia persists despite fibrate therapy.

9 10 11 12 13 Years of Follow-up

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