Patient With T2DM and CKD at Risk of New-Onset AF

A 66-year-old man presents to your general cardiology clinic for routine follow-up. His medical history includes type 2 diabetes mellitus (T2DM) since the age of 45 with mild retinopathy, hypertension, chronic kidney disease (CKD) stage 3, hyperlipidemia, and obstructive sleep apnea. His medications are metformin 1000 mg twice daily, dapagliflozin 10 mg daily, lisinopril 40 mg daily, aspirin 81 mg daily, and atorvastatin 40 mg daily. His most recent laboratory results from his primary care physician visit the previous week follow:

  • Sodium = 136 mEq/L
  • Potassium = 4.0 mEq/L
  • Creatinine = 1.40 mg/dL
  • Estimated glomerular filtration rate = 55 mL/min/1.73m2
  • Hemoglobin A1C = 7.1%
  • Low-density lipoprotein = 82 mg/dL
  • Urine microalbumin/Cr = 180 mg/g

He has an extensive family history of atrial fibrillation (AF), with both his parents and his older sister requiring multiple electrical cardioversions and catheter ablations. Today he has no complaints and denies any palpitations. The electrocardiograms performed at previous visits all showed normal sinus rhythm. The most recent transthoracic echocardiogram 6 months ago showed a left ventricular ejection fraction of 60% and no valvular abnormalities. He inquires if there are ways to decrease his risk of developing AF in the future.

Which one of the following medications has been shown to reduce the risk of new-onset AF in patients like this one?

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