58-Year-Old Male Patient With CKD and T2DM

A 58-year-old male patient with type 2 diabetes mellitus (T2DM), hypertension, hyperlipidemia, coronary artery disease, and chronic kidney disease (CKD) presents to you for routine follow-up. He was hospitalized 1 year ago for an acute myocardial infarction (MI) and underwent revascularization of the right coronary artery with a drug-eluting stent. On physical exam, his heart rate is 62 bpm and blood pressure is 138/60 mmHg. There is no jugular venous distension, his lungs are clear to auscultation, and he has no peripheral edema. His laboratory evaluation includes an estimated glomerular filtration rate of 48 mL/min/1.73m2, low-density lipoprotein of 50 mg/dL, and hemoglobin A1c of 6.8%. Echocardiography demonstrates a left ventricular ejection fraction of 50%. He is currently on aspirin 81 mg daily, ticagrelor 90 mg twice daily, metoprolol succinate 100 mg daily, atorvastatin 80 mg daily, losartan 100 mg daily, and metformin 1 gm daily.

Based on the result of a large, randomized trial, which of the following additional therapies is likely to improve this patient's cardiac outcomes?

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