Which client would be least appropriate for starting an anti-hyperlipidemic medication?

• A. A 57-year-old client who has cirrhosis related to alcohol abuse
• B. A 30-year-old client who has a history of heart disease
• C. A 44-year-old client who has recurrent urinary tract infections
• D. A 79-year-old client who has bilateral cataracts

Answer: (A)

The key idea is safety of lipid-lowering therapy in the context of liver disease. These drugs, especially statins, are metabolized by the liver and can cause liver enzyme elevations or hepatotoxicity. In a client with cirrhosis, the liver’s capacity to process the medication is compromised, increasing the risk of drug-induced liver injury. Because of that, starting an anti-hyperlipidemic medication is least appropriate in this case.

The other scenarios don’t present a hepatic contraindication: a patient with known heart disease is typically a strong candidate for statin therapy to reduce recurrent cardiovascular events; a younger patient without liver disease is not contraindicated; and cataracts are not a reason to avoid lipid-lowering therapy.