There are a few options, most of which depend on insurance coverage and patient preferences. But first, would do a chart biopsy to assess the efficacy of each of the therapies to better understand the reason for persistent LDL elevation. Perhaps they have a dysfunctional LDL receptor, so upregulatio...

Challenging and agree that compliance is something I would be concerned about. If compliance not the reason patient not at goal, colchicine would be a cheap option to lower risk via an orthogonal pathway of inflammation, particularly if the patient had an elevated hsCRP. Bempedoic acid would be my n...