Navigating Recent Clinical Trial Results: Cardiovascular Risk Reduction in a Patient with Clinical ASCVD and Diabetes-Associated Microvascular Complications

63 year-old female presents for follow-up in clinic.

PMH: CAD, HTN, type 2 diabetes (11 years), CKD (Stage 3), osteoporosis, diabetic retinopathy, microalbuminuria, frequent urinary tract infections (UTIs)

alendronate 70 mg PO weekly
aspirin 81 mg PO daily
atorvastatin 40 mg po daily
chlorthalidone 25 mg PO daily
insulin glargine 20 units daily
lisinopril 40 mg PO daily
metformin 1000 mg PO twice daily
sulfamethoxazole/trimethoprim 400 mg-80 mg PO three times per week

Vitals: BP: 130/80 mm Hg, P: 68 beats per minute, BMI 31.1 kg/m2
Labs: eGFR 50 mL/min/1.73m2, liver function normal, A1C: 8.5%

The patient states adherence with appropriate lifestyle habits.

During the clinician-patient discussion at today's visit, you express concern about the patient's high atherosclerotic cardiovascular disease risk. The patient states she is willing to take additional medications to lower her risk.

Which ONE of the following medications will be the safest addition to the patient's current regimen to reduce her cardiovascular risk and blood glucose?

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