In managing a patient with a history of myocardial infarction and an LDL-C of 76 mg/dL, what is the recommended next step for treatment?

Adding ezetimibe as the next step in therapy is appropriate for a patient with a history of myocardial infarction (MI) and a low-density lipoprotein cholesterol (LDL-C) level of 76 mg/dL. Current guidelines recommend that in patients who are post-MI and have an LDL-C level above 70 mg/dL, intensifying lipid-lowering therapy is indicated to further reduce cardiovascular risk.

Ezetimibe effectively lowers LDL-C levels by inhibiting intestinal absorption of cholesterol, making it a suitable option when primary therapy, such as statins, does not achieve the optimal LDL-C target. Given that this patient has an LDL-C level that is relatively close to the recommended cutoff for secondary prevention in the setting of coronary artery disease, adding ezetimibe can help to achieve additional LDL-C reduction and potentially improve patient outcomes.

The decision to add ezetimibe is especially relevant in cases where statin therapy alone does not bring the LDL-C under the desirable threshold, thereby reinforcing the strategy of aggressive lipid management in patients with cardiovascular history.