Question of the Week
For June 30, 2015
A 56-year-old man with a history of stage 1 hypertension and obesity presents for follow-up related to his blood pressure and lipid levels. He currently takes no medications. He is 180 cm tall, weighs 107 kg, and has a BMI of 33. His blood pressure is 138/86 mm Hg. His father and one brother had myocardial infarctions at ages 51 and 52, respectively. During the past year, he has tried to adopt a low-fat diet and increase his exercise level, but he has had minimal success.
His fasting morning laboratory findings are as follows:
| Patient value | Reference range |
Glucose (mg/dL) | 90 | 70–100 |
Glycated hemoglobin (%) | 5.6 | 4.3–5.6 |
Total cholesterol (mg/dL) | 213 | — |
LDL cholesterol (mg/dL) | 126 | — |
HDL cholesterol (mg/dL) | 35 | — |
Triglycerides (mg/dL) | 260 | — |
The patient’s estimated 10-year risk for atherosclerotic cardiovascular disease is 9.0% according to the risk calculator of the American College of Cardiology and American Heart Association.
Which one of the following medications is most appropriate for this patient?