The Use of Lipid Modifying Agents in Secondary ASCVD Prevention

A 62-year-old man presents to your clinic for follow-up.

Past Medical History: Myocardial infarction at age 60 years with drug eluting stent to the right coronary artery, hypertension, type 2 diabetes mellitus, and mixed hyperlipidemia.

Medications: Aspirin 81 mg PO daily, lisinopril 10 mg PO daily, metformin 1 g PO twice daily, liraglutide 1.2 mg SC daily and rosuvastatin 20 mg PO daily.

Allergies: None

Vitals: Blood pressure: 117/75 mm Hg; heart rate: 71 beats per min; weight: 203 lbs; BMI: 27.3kg/m2.

Labs: TC 134 mg/dL, TG 235 mg/dL, HDL-C 32 mg/dL, LDL-C 55 mg/dL, non-HDL-C = 102 mg/dL, fasting glucose 108 mg/dL, A1c 6.4%.

Since his coronary event, the patient has been working on his diet and increasing his exercise. He remains asymptomatic and is adherent to his current medication regimen. During the clinician-patient discussion, he expresses concern about having another heart attack and wants to know if there is anything else that can be done to further reduce his risk for another event.

In addition to continuing with lifestyle modification, which of the following lipid modifying agents would you recommend adding to the patient's current medication regimen to further reduce his risk for future atherosclerotic cardiovascular disease (ASCVD) events?

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