A fasting lipid panel is the most appropriate laboratory test for this patient. He has a history of atherosclerotic cardiovascular disease and is being treated with high-intensity statin therapy in accordance with the American College of Cardiology/American Heart Association cholesterol treatment guideline. Before initiating statin therapy, a fasting lipid panel, including total cholesterol, triglyceride, HDL cholesterol, and LDL cholesterol levels, should be obtained. Although therapy is not adjusted to achieve specific LDL cholesterol targets, a repeat fasting lipid panel is appropriate 1 to 3 months after initiation of statin therapy to determine medication adherence and effectiveness of treatment, which is defined as a reduction in the LDL cholesterol level of 50% or more from the pretreatment baseline. Further monitoring of statin therapy should be individualized, but in patients on a stable dose, the guidelines recommend retesting at 3- to 12-month intervals.

Alanine aminotransferase level should be measured before initiating therapy to rule out undiagnosed liver disease; however, based on the low risk of hepatotoxicity, the FDA no longer suggests measurement of hepatic enzymes during statin therapy. If the patient experiences symptoms suggestive of liver dysfunction, including fatigue, anorexia, jaundice, nausea, or abdominal pain, assessment of hepatic aminotransferases would be appropriate.

Baseline assessment of creatine kinase level is useful in patients with a family history of myopathy or risk factors for statin-induced myopathy (for example, concomitant therapy with medications that alter statin metabolism). Routine creatine kinase assessment is low yield and cost ineffective, as the incidence of myopathy is relatively rare. For this patient without symptoms or risk factors for myopathy, neither initial creatine kinase measurement nor testing during statin therapy is indicated.

Elevated high-sensitivity C-reactive protein level is a risk factor for cardiovascular disease and may be useful in patients for whom the best therapeutic approach for hyperlipidemia is uncertain. However, this patient has a clear indication for high-intensity statin therapy based on his clinical atherosclerotic cardiovascular disease. Therefore, high-sensitivity C-reactive protein testing is not indicated.