CASE 30
A 48-year-old male presents to the clinic because of concerns about heart dis-
ease. He reports that his father died from a heart attack at age 46, and his older
brother has also had a heart attack at age 46 but survived and is on medications
for elevated cholesterol. The patient reports chest pain occasionally with
ambulation around his house and is not able to climb stairs without significant
chest pain and shortness of breath. The physical exam is normal, and the
physician orders an electrocardiogram (ECG), exercise stress test, and blood
work. The patient’s cholesterol result comes back as 350 mg/dL (normal 200).
The physician prescribes medication, which he states is directed at the rate-
limiting step of cholesterol biosynthesis.
What is the rate-limiting step of cholesterol metabolism?
What is the class of medication prescribed?
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