Cardiovascular Risk Reduction in a Patient with Coronary Artery Disease and Diabetes

Case Presentation:

57 year-old male presents for follow-up in clinic.

PMH: Hypertension, non-ST segment elevation myocardial infarction (NSTEMI) 2 years ago, type 2 diabetes

aspirin 81 mg PO daily
lisinopril/hydrochlorothiazide 20 mg/12.5 mg 2 tablets PO daily
metoprolol XL 50 mg PO twice daily
metformin 1000 mg PO twice daily

Vitals: BP: 132/88 mm Hg, P: 62 beats per minute, BMI 27 kg/m2
Labs: Kidney/liver function normal, A1C: 7.5%
Lipids (mg/dL): Total Cholesterol: 202, Triglycerides: 200, HDL-C: 32, LDL-C: 130

The patient states adherence with appropriate lifestyle habits.

During the clinician-patient discussion at today's visit, you express concern about the patient's high atherosclerotic cardiovascular disease risk. The patient states he is willing to take additional medications to lower his risk.

According to the American Diabetes Association (ADA) Standards of Medical Care in Diabetes, which ONE of the following should be added to the patient's current regimen to reduce this patient's cardiovascular risk?

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