A 60-Year-Old Man With Uncertainty in Lipid Rx After Risk Estimation | Patient Case Quiz

A 60-year-old asymptomatic man presents for routine follow-up, concerned about the potential need for statin therapy. He has hypertension, but denies diabetes or present/prior tobacco use. His family history is not significant for premature coronary artery disease (CAD). The patient is overweight, and he has been exercising three times a week (treadmill for 20 minutes) and following a Mediterranean style diet.

His exam is unremarkable with a treated blood pressure of 128/78 mm Hg and body mass index (BMI) of 30.5.

His labs are as follows:

  • Total Cholesterol: 206
  • Low-Density Lipoprotein Cholesterol (LDL-C): 124
  • High-Density Lipoprotein Cholesterol (HDL-C): 48
  • Triglycerides: 164
  • Fasting Blood Glucose: 114

After discussing the potential role of a statin given an estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk of 10.6% by the new risk estimator, the patient is still very concerned. He has heard multiple negatives about long-term statin use, including the potential for diabetes, especially given his abnormal blood glucose.

Which of the following would be the next step in management of this patient?

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