Reducing Cardiovascular Risk in a Patient with Peripheral Artery Disease and Diabetes

Mr. Young is a 63-year-old African American man who has been recently diagnosed with lower extremity peripheral artery disease (PAD). He states, "My legs hurt when I walk, and I can hardly make it out to my mailbox."

PMH: Hypertension, diabetes mellitus type 2

Family History: mother and brother with history of diabetes, father died at age 72 of myocardial infarction

Social History: non-smoker, 4 ounces of alcohol per week

Medications:

  • aspirin 81 mg PO daily
  • amlodipine besylate 5 mg PO daily
  • atorvastatin 40 mg PO daily
  • cilostazol 100 mg PO two times daily
  • lisinopril/hydrochlorothiazide 20 mg -- 12.5 mg PO daily
  • metformin 1000 mg PO twice daily

Vitals: BP: 148/06 mm Hg, P: 74 beats per minute, RR: 14 breaths per minute, Height: 5'6" Weight: 185 lbs

Labs: Cr: 1.2 mg/dL, AST: 12 units/L, ALT: 23 units/L, A1C: 8.1%
Total Cholesterol: 162 mg/dL, Triglycerides: 200 mg/dL, HDL-C: 32 mg/dL, LDL-C: 90 mg/dL

The patient states adherence with appropriate dietary 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 he is willing to take non-injectable medications to lower his cardiovascular risk and improve symptoms.

Which one of the following medications would be the best choice to lower this patient's cardiovascular risk?

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