Patients taking which cholesterol-lowering agent may require supplements of fat-soluble vitamins A, D, E, and K?

Lifestyle is the greatest contributing factor that can lead to many diseases, especially noncommunicable diseases (NCDs) such as cardiovascular diseases, cancers, chronic respiratory diseases and diabetes.According to the World Health Organization (WHO), NCDs are responsible for 74% of all deaths worldwide, and they share four major risk factors: tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets.These modifiable behaviours increase the risk of metabolic risk factors such as raised blood pressure, increased blood glucose, elevated blood lipids and obesity, which can lead to NCDs.

Choice A is wrong because trauma is not a factor that can lead to many diseases, but rather a result of injuries or accidents that damage the body.Trauma can cause acute or chronic conditions, such as infections, bleeding, fractures, organ failure or post-traumatic stress disorder, but it is not a common cause of NCDs.

Choice C is wrong because congenital means present at birth or inherited.

Congenital diseases are caused by genetic mutations or environmental factors that affect the development of the fetus.

Some examples of congenital diseases are Down syndrome, cystic fibrosis, congenital heart defects and spina bifida.

Congenital diseases are not the greatest contributing factor to many diseases because they are relatively rare and often detected early.

Choice D is wrong because genetics refers to the inherited traits from parents that influence the risk of developing certain diseases.

Genetics can play a role in some NCDs, such as cancers, diabetes and some cardiovascular diseases, but it is not the only or the most important factor.

Genetics interacts with environmental and lifestyle factors to determine the likelihood of developing a disease.

Therefore, genetics alone cannot lead to many diseases.

Atorvastatin is a type of statin, which are the most potent antilipidemic agents and have proven to lower the risk of myocardial infarction. Statins work by inhibiting an enzyme called HMG-CoA reductase, which is involved in the synthesis of cholesterol in the liver.By reducing the production of cholesterol, statins lower the levels of low-density lipoprotein (LDL) and triglycerides, and slightly increase the levels of high-density lipoprotein (HDL) in the blood.

Choice B, niacin, is wrong because niacin is not as effective as statins in lowering LDL and preventing cardiovascular events.Niacin is a water-soluble vitamin that can lower LDL and triglycerides, and increase HDL, but it can also cause flushing, itching, and liver toxicity.

Choice C, gemfibrozil, is wrong because gemfibrozil is a type of fibric acid derivative, which are mainly used to lower triglycerides and increase HDL, but have little effect on LDL.

Fibric acid derivatives work by activating a receptor called PPAR-alpha, which regulates the metabolism of lipids in the liver and muscle.Fibric acid derivatives can also increase the risk of gallstones and muscle damage.

Choice D, ezetimibe, is wrong because ezetimibe is a selective cholesterol absorption inhibitor, which blocks the absorption of dietary and biliary cholesterol in the intestine.Ezetimibe can lower LDL by about 15-20%, but it has not been shown to reduce the risk of myocardial infarction on its own.Ezetimibe is usually combined with a statin for better efficacy and safety.

Normal ranges for lipid levels are:

• Total cholesterol: less than 200 mg/dL

• LDL cholesterol: less than 100 mg/dL

• HDL cholesterol: more than 40 mg/dL for men and more than 50 mg/dL for women

• Triglycerides: less than 150 mg/dL