Hypolipidemics

Which of the following statins undergoes the LEAST hepatic metabolism and is therefore safest in patients with severe liver disease?

A 58-year-old man with type 2 diabetes mellitus and hypertension presents for routine follow-up. His lipid profile shows: Total cholesterol 280 mg/dL, LDL-C 180 mg/dL, HDL-C 35 mg/dL, triglycerides 320 mg/dL. He is already on atorvastatin 40 mg daily but remains at high cardiovascular risk. His liver function tests and creatine kinase are normal. Which of the following is the most appropriate next step in management?

A 52-year-old man with type 2 diabetes mellitus and hypertension presents with LDL cholesterol of 180 mg/dL and triglycerides of 320 mg/dL despite lifestyle modifications. His HDL cholesterol is 35 mg/dL. Which is the drug of choice for initial management of his dyslipidemia?

A 58-year-old woman with coronary artery disease and an LDL cholesterol of 95 mg/dL on atorvastatin 40 mg daily presents for lipid management optimization. Her cardiologist recommends further LDL reduction to <70 mg/dL. Which drug should be added to achieve this goal?

A 52-year-old man with a history of myocardial infarction 6 months ago is started on atorvastatin 40 mg daily. After 8 weeks of therapy, you need to assess the efficacy and safety of the statin. Which investigation is most appropriate to monitor the response to therapy and detect potential hepatotoxicity?