Determining Appropriate Lipid-reduction Therapy in Patients with Type 2 Diabetes Mellitus

BM is a 58-year-old African American male with a history of type 2 diabetes, chronic kidney disease, and hypertension who returns to clinic for follow up on lipid management.

The patient states he has been adherent to maximal lifestyle modifications and pharmacotherapy. He walks his dog 30 minutes a day for 5 days a week.

Past Medical History
Type 2 Diabetes
Chronic Kidney Disease (55 mL/min)

Patient does not have any known history of atherosclerotic cardiovascular disease (ASCVD).

Social History
Tobacco - smokes 14 cigarettes per day for 15 years; not willing to quit.
denies alcohol use

Current Medications
Metformin 500 mg PO twice daily
Aspirin 81 mg PO daily
Lisinopril 2.5 mg PO daily
Rosuvastatin 40 mg PO daily

Ht 5'10'' Wt 230 lbs. BMI 33 kg/m2 BP 128/80 mmHg HR 76 bpm RR 14

Other parts of the physical exam were unremarkable.

Labs (3 months ago)
Fasting lipid panel: TC 206 mg/dL, HDL-C 40 mg/dL, LDL-C 132 mg/dL, triglycerides 170 mg/dL
A1c: 6.5%
Other labs and physical exam were within normal limits

10-year ASCVD risk was estimated to be 37.2% by the Pooled Cohort Equation.

Rosuvastatin 40 mg PO daily was prescribed 3 months ago.

Today's Fasting Lipid Panel
Total Cholesterol: 180 mg/dL
HDL-C: 40 mg/dL
LDL-C: 90 mg/dL
Triglycerides: 150 mg/dL

According to the 2018 AHA/ACC Guidelines on the Management of Blood Cholesterol, which ONE of the following choices is the best therapy for this patient to further reduce ASCVD risk?

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