A 57-year-old retired critical care nurse was seen in the emergency department of a local hospital with classic signs and symptoms of angina pectoris. The patient had a 4-year history of diabetes mellitus type II, controlled with a low-carbohydrate, weight-reducing diet and a 10-year history of essential hypertension, controlled with an angiotensin-converting enzyme inhibitor (ACEi) and a β-blocker. An excessive hyperlipidemia was treated with a statin on an above-average dose, plus ezetemide, a lipid-lowering compound that selectively inhibits the intestinal absorption of cholesterol. Blood lipids were maintained at therapeutic levels, (eg, total cholesterol, 4.34 mmol/L [168 mg/dL]; triglycerides, 1.41 mmol/L [125 mg/dL]; low-density lipoprotein [LDL], 1.94 mmol/L [75 mg/dL]; and high-density lipoprotein [HDL], 1.71 mmol/L [66 mg/dL]). In the past 18 months, she had infrequent and predictable angina with effort, 1 or 2 attacks per month; however, in the...

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