Management of Dyslipidemia

A 56-year-old Hispanic male is referred to the clinic for dyslipidemia management.

His past medical history is significant for type 2 diabetes mellitus (T2D) (diagnosed 12 years prior), diabetic neuropathy, and hypertension (HTN). He does not have a history of clinical atherosclerotic cardiovascular disease (ASCVD).

Family history: father with HTN (deceased at age 72 due to myocardial infarction); mother with T2D (alive, diagnosed 25 years prior) and transient ischemic attack (age 64); siblings with HTN (alive).

Social history: drinks 2-3 glasses of alcohol weekly; denies tobacco or illicit drug use.

Current medications:

  • lisinopril 20 mg PO daily
  • metformin 500 mg PO bid
  • glipizide 5 mg PO daily
  • hydrochlorothiazide 25 mg PO daily
  • pregabalin 75 mg PO bid

Physical examination:
Height: 5'10'; weight 202 lbs; body mass index 29 kg/m2; waist circumference of 38"; T 98.6°F (37°C); BP 128/78; HR 88; RR 18

His estimated 10-year ASCVD risk is around 11%.

Otherwise, the results of the physical examination were unremarkable.

Most recent lipid panel:

  • Total Cholesterol: 238 mg/dL
  • Triglycerides: 170 mg/dL
  • High-Density Lipoprotein Cholesterol (HDL-C): 38 mg/dL
  • Friedewald-Estimated Low-Density Lipoprotein Cholesterol (LDL-C): 166 mg/dL

Fasting glucose 89; A1c 5.2%; urine albumin 62 mcg of albumin/mg creatinine

His creatinine, liver enzymes, thyroid stimulating hormone (TSH) and vitamin D levels are within normal limits.

His diabetes and blood pressure are well-controlled on his current regimen. The patient was counseled on lifestyle modifications.

According to the 2018 ACC/AHA cholesterol guidelines, which ONE of the following choices is the best therapy for this patient to reduce ASCVD risk?

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