Your patient is an obese 38-year-old female with a fasting lipid panel of TC 270, LDL 168, HDL 28. What is your action?

Starting a statin is appropriate in this scenario due to the patient's elevated cholesterol levels and obesity. The fasting lipid panel indicates high total cholesterol (TC) at 270 mg/dL and LDL cholesterol (LDL) at 168 mg/dL, both of which are above the recommended values. LDL cholesterol, often referred to as "bad" cholesterol, is particularly concerning when it is at these levels, as it is associated with an increased risk of cardiovascular disease.

Statins are first-line therapy for managing high LDL levels because they have been shown to effectively lower LDL cholesterol and subsequently reduce the risk of heart attacks and strokes. Given the patient's obesity and cholesterol profile, initiating statin therapy would be a proactive measure to mitigate these cardiovascular risks.

While teaching lifestyle changes is important and should be part of an overall treatment plan, it typically complements pharmacologic intervention rather than replaces it, especially when lipid levels indicate a need for immediate action. Prescribing metformin would not be relevant as the primary concern here is dyslipidemia rather than blood glucose control, and the indication for niacin is less favored in current guidelines compared to statins. Thus, initiating a statin is the most clinically appropriate action in this case.