A 70-year-old Asian American man who has signs of hemoconcentration that may be due to plasma contraction also has the following lipid levels: total cholesterol 91 mg/dL, triglycerides 64 mg/dL, LDL 39 mg/dL, HDL 39 mg/dL, and cholesterol-to-HDL ratio 2.3. He takes atorvastatin (Lipitor) and ezetimibe (Zetia) 10 mg each daily. His past history includes quadruple coronary bypass four years ago. At approximately what lipid levels will he lose his atheroma burden?
—Mahmud Syed, MD, Troy, Mich.

The lipid levels he has now are about as good as you’ll ever see. Theoretically, his atheroma should shrink as the months and years go by, and this is borne out by recent clinical data. For example, in one study using intravascular ultrasound to measure coronary artery plaque volume in patients with acute coronary syndromes, six months of aggressive lipid- lowering therapy resulted in significant plaque reduction (Circulation. 2004;110:1061-1068).
—Peter F. Cohn, MD