Personalized Management of Dyslipidemia in 2013
A 62-year-old woman presents to your office for follow-up. She has stable multivessel coronary artery disease (normal stress echocardiogram four months ago and no angina symptoms), hypertension, noninsulin dependent diabetes mellitus, and dyslipidemia. She has stents deployed in her proximal RCA and mid LAD. She has nonobstructive plaque in multiple other regions of her coronary vasculature. She has been diabetic for approximately 13 years. She had difficulty controlling her blood glucose levels until one year ago. She lost 45 lbs, quit smoking, and now ambulates two miles daily. Her BMI is 29 kg/m2. She has microalbuminuria, hepatic steatosis, and early proliferative retinopathy that has not yet required laser photocoagulation. She has no history of peripheral vascular disease or claudication. Blood pressure is 120/70 mm Hg and resting pulse is 68 bpm.
Current medications include ramipril 10 mg po qd, aspirin 81 mg po qd, clopidogrel 75 mg po qd, carvedilol 12.5 mg po bid, rosuvastatin 40 mg po qd, metformin 1000 mg po bid, and exenatide 10 mg SQ bid. Hemoglobin A1c is 6.8%, creatinine 1.0 mg/dL, and serum electrolytes and normal thyroid indices. Lipid profile shows LDL-C 67 mg/dL, non-HDL-C 93 mg/dL, HDL-C 29 mg/dL, and triglycerides 370 mg/dL.
The patient's BP and diabetes are both well controlled. Given her comorbidities and lipid profile results, which of the following medications would you consider adding in order to more optimally control all components of her lipid profile?