Question of the Week

For June 30, 2015

A 46-year-old man with a history of hypertension and obesity presents for follow-up related to his blood pressure and lipid levels. He is 180 cm tall, weighs 107 kg, and has a BMI of 33. His blood pressure is 138/86 mm Hg while he is taking oral hydrochlorothiazide 25 mg daily. His father and one brother had myocardial infarctions at ages 51 and 52, respectively.

The patient was previously taking rosuvastatin but discontinued it several months ago after reading a newspaper article suggesting that statin use can increase the risk for type 2 diabetes.

His fasting morning laboratory findings today, while he is off rosuvastatin, are as follows:

Patient value

Reference range

Total cholesterol (mg/dL)

213

125–200

LDL cholesterol (mg/dL)

150

<130

HDL cholesterol (mg/dL)

35

≥40

Triglycerides (mg/dL)

140

<150

Glucose (mg/dL)

97

70–100

High-sensitivity C-reactive protein (mg/liter)

3.10

0.02–8.00

The patient’s estimated 10-year risk for atherosclerotic cardiovascular disease is 9.3%.

Which one of the following options is most appropriate for this patient?

Initiate ezetimibe and valsartan
Continue to withhold rosuvastatin and initiate atenolol
Continue to withhold rosuvastatin and initiate aspirin
Continue to withhold rosuvastatin and initiate metformin
Reassure the patient and restart rosuvastatin