Assessing Need for Statin Therapy in Older Adults

AJ is a 78-year-old African American female with hypertension, prediabetes, and chronic kidney disease who presents to the primary care physician's (PCP) clinic for her annual wellness visit. She is asymptomatic, follows a low sodium diet but does not follow a low-fat diet.

Height: 67 inches; Weight: 155 pounds, Blood pressure 128/78; Pulse: 66; BMI: 24.3

Past medical history: hypertension, prediabetes

Family history: mother had a heart attack at 54 years old; father noncontributory

Social history: denied smoking or drinking

Medications: lisinopril/hydrochlorothiazide 10mg/25 mg PO daily

Today's lipid panel (mg/dL): total cholesterol 200, HDL-C 55, triglycerides 115, LDL-C 145

With a 10-year atherosclerotic cardiovascular disease (ASCVD) risk score of 17.4% and no history of clinical ASCVD, the PCP recommends initiation of lifestyle changes such as the DASH diet and exercising and use of a moderate intensity statin. During the clinician-patient discussion, the patient stated that she is willing to make lifestyle changes; however, she prefers not to initiate another medication.

According to the 2018 ACC/AHA multisociety cholesterol guideline, which ONE of the following choices is the best option at this time?

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