Step 2

Primary 2

A 56-year-old woman presents to her primary care physician for a routine follow up. She has a history of hypertension and type 2 diabetes mellitus for which she is taking lisinopril 20mg and metformin 500mg twice daily. Her last HbA1C was 6.3% two months ago. She has no acute complaints. She does not smoke, but occasionally has a glass of wine on the weekends. She has been eating a healthier diet with more fiber and fruits in the past couple months, and she has been trying to exercise at least once a week by walking 2-3 miles. Vital signs include blood pressure is 122/60mmHg, heart rate 68 beats/min, and respirations 16/min with oxygen saturation of 99% on room air. Her lipid panel shows:

  • Total cholesterol 167 mg/dl
  • HDL cholesterol 43 mg/dl
  • LDL cholesterol 101 mg/dl
  • Triglycerides 175 mg/dl
  • Her 10-year risk of cardiovascular event is calculated to be 5.3%

Which of the following is the most appropriate next step in management?

  • A) Atorvastatin 40mg daily
  • B) Co-Q10 supplement daily
  • C) Omega-3 fish oil supplement daily
  • D) Pravastatin 20mg daily
  • E) Simvastatin 20mg daily


Yunjia Shen


Dr. Raj Dasgupta