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Murray A. Mittleman, MD, DrPH, Discussant

JAMA. 2006;296:319-326.

Ms T, a 39-year-old woman, has a total cholesterol level of 277 mg/dL (7.17 mmol/L) and well-controlled hypertension; her brother had a stroke in his 30s. She is primarily concerned with her mother’s history of breast cancer, but she would like to know if she can take a dietary supplement or if she needs to take cholesterol-lowering medication, and if so, whether she will need to continue it as well as adhere to her diet for the rest of her life. Her estimated 10-year risk of developing coronary heart disease (CHD) is 1% to 2% using the Framingham Risk Score, but that may underestimate her true risk as an African American woman with a family history of CHD. Recommendations for her, her longer-term risk for CHD, and evidence for lipid-lowering therapies are discussed.

Author Affiliation: Dr Mittleman is Associate Professor of Medicine, Harvard Medical School, and Associate Professor of Epidemiology, Harvard School of Public Health, Boston, Mass.