A 49-year-old man is evaluated during a health maintenance visit for his type 2 diabetes mellitus (DM) and hypertension. Current medications are metformin, empagliflozin, chlorthalidone, and candesartan (patient had ACE-inhibitor induced cough). On physical exam, vital signs are normal. Body mass index (BMI) is 25. Triglyceride level is 195 mg/dL. His 10-year risk for atherosclerotic cardiovascular disease (ASCVD) is 4.2%. After a thorough discussion concerning the various cholesterol guidelines, the patient agrees to follow the American Heart Association/American College of Cardiology (AHA/ACC) recommendations for cholesterol management.
Which of the following is the most appropriate treatment?
- A) High-intensity atorvastatin
- B) Fenofibrate
- C) Moderate intensity rosuvastatin
- D) Red yeast rice
- E) Colestipol
C) Moderate intensity rosuvastatin
Primary prevention of cardiovascular disease (CVD) in a patient with type 2 DM with statin therapy is recommended based on 2 major guidelines which are the AHA/ACC and the U.S. Preventive Services Task Force (USPSTF).
AHA/ACC recommends initiating moderate-intensity statin therapy in adults aged 40 to 75 years with DM, regardless of the calculated ASCVD risk.
The USPSTF recommends that adults without a history of CVD use a low- to moderate-dose statin for the prevention of cardiovascular events when all of the following criteria are met: (1) they are 40 to 75 years of age; (2) they have one or more CVD risk factors (i.e., dyslipidemia, diabetes, hypertension, or smoking); and (3) they have a calculated 10-year ASCVD event risk of 10% or greater.
Dr. Raj Dasgupta
Dr. Raj Dasgupta