For a 69-year-old woman with statin intolerance, what is the most appropriate recommendation to reduce her ASCVD risk?

In managing a 69-year-old woman with statin intolerance who requires support in reducing her atherosclerotic cardiovascular disease (ASCVD) risk, the recommendation to add evolocumab 140 mg subcutaneously every 2 weeks is particularly appropriate. Evolocumab is a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, which significantly lowers low-density lipoprotein cholesterol (LDL-C) levels. Clinical trials have shown that PCSK9 inhibitors not only effectively lower cholesterol levels but also reduce cardiovascular events, making them suitable for patients who cannot tolerate statins or require further LDL-C reduction despite maximal statin therapy.

On the other hand, while the other options also contribute to lipid management, they do not provide the same degree of efficacy in reducing cardiovascular risk in the context of statin intolerance. Colesevelam, for instance, is a bile acid sequestrant that can lower LDL-C, but its effect on cardiovascular outcomes is less robust compared to that of evolocumab. Fenofibrate primarily lowers triglycerides and has limited evidence supporting its use for ASCVD risk reduction in patients with statin intolerance. Omega-3 fatty acids can lower triglyceride levels but do not significantly affect LDL