Racing to Normal: A Case Report of Rapid and Notable Cholesterol Reduction With Statin and Ezetimibe Combined Therapy

Severe mixed dyslipidemia is a major risk factor for cardiovascular disease (CVD), necessitating early and intensive lipid-lowering interventions. This case report describes the management of a 40-year-old patient with extreme dyslipidemia and high cardiovascular risk, emphasizing the impact of pharmacological therapy and lifestyle modifications. Initial therapy included rosuvastatin 20 mg, ezetimibe 10 mg, and fenofibrate 145 mg, combined with smoking cessation, alcohol restriction, and dietary changes. The combined therapy resulted in progressive improvement, with final lipid levels at 16 months showing total cholesterol of 95 mg/dL, low-density lipoprotein cholesterol (LDL-C) of 11.7 mg/dL, high-density lipoprotein cholesterol (HDL-C) of 28.2 mg/dL, and triglycerides of 275 mg/dL. Echocardiographic and vascular studies confirmed atherosclerosis without significant luminal stenosis. Genetic testing for familial hypercholesterolemia was negative. This case highlights the effectiveness of early combination therapy and lifestyle modification in managing severe dyslipidemia. The substantial lipid reduction achieved reinforces current recommendations for early and aggressive treatment in high-risk patients. Continuous monitoring and individualized therapy adjustments remain essential for long-term cardiovascular risk reduction.