Many students will get this question wrong because of a similar question on Uworld. This patient has an extremely high triglyceride level and has no history of cardiovascular disease. Fibrates should be prescribed to prevent pancreatitis.

So this patient has high TOTAL colesterol and TRIGLYCERIDES. Statin may be a choice because its first line therapy for cholesterol reduction. However in this case the patient has very high Triglycerides and first line therapy for Hypertrigliceridemia are Fibrates

How to rule out Simvastatin: statins are used to lower LDL not Total cholesterol so use LDL equation -> LDL= Total cholesterol- HDL - (TGS/5)

Hope this help, I'm sorry if someone else posted it as a comment, my comments are scrambled and I don't want to pay more money for this test.

According to UpToDate:

At levels below 886 mg/dL (10.0 mmol/L), the risk of pancreatitis appears to be quite small [76-78]; however, it is reasonable to consider drug therapy at levels of 500 mg/dL (5.6 mmol/L) or above in patients with a prior episode of pancreatitis.

Bonus: They say fenofibrate>gemfibrozil always.

According to the AHA every patient with TG above 500 should receive fibrates, even though statins can decrease TG levels.