Question of the Week

For November 18, 2014

A 67-year-old woman with type 2 diabetes and hypertension presents for follow-up. In the 6 months since her last visit, she has lost 4.5 kg of body weight through diet and exercise. She currently takes metformin 1000 mg twice daily, lisinopril 20 mg daily, aspirin 81 mg daily, and a multivitamin.

Her blood pressure is 123/74 mm Hg, and her BMI is 22.8. The rest of her physical examination is unremarkable.

A fasting lipid panel reveals the following results:

Patient value

Reference range

Total cholesterol (mg/dL)

189

125–200

LDL cholesterol (mg/dL)

95

<130

HDL cholesterol (mg/dL)

43

≥46

Triglycerides (mg/dL)

255

<150

Liver-function tests are within normal limits, and the patient’s glycated hemoglobin level is 6.3% (reference range, 3.8–5.6).

The patient’s estimated 10-year risk for atherosclerotic cardiovascular disease is 16.7%.

Which one of the following treatments is recommended to minimize this patient’s long-term cardiovascular risk?

Fenofibrate 145 mg daily
Eicosapentaenoic acid fish oil 2 grams twice daily
Atorvastatin 80 mg daily
Extended-release niacin 500 mg daily
Pravastatin 20 mg daily