A 44-year-old woman has a 10-year history of type 2 diabetes. She is a nonsmoker with
well-controlled hypertension and microalbuminuria. She is on dietary management,
metformin, and takes one omega-3 fatty acid capsule with 840 mg of EPA and DHA. She
also takes lisinopril/hydrochlorothiazide for her blood pressure. She has a family history
of diabetes, but not premature ASCVD. She has a BP 134/78 and a BMI of 36.0. Her
fasting lipid panel reveals an LDL-C 95 mg/dL, triglycerides 350 mg/dL, and HDL-C 38
mg/dL. Her hemoglobin A1c is 7.5%.
a. Her LDL-C is under 100 mg/dL so she is at “goal” and does not require a
b. She should start simvastatin 20 mg and fenofibrate 160 mg daily.
c. To reduce her risk of an ASCVD event, the dose of omega-3 fatty acid
should be increased to 4 capsules daily to lower her triglycerides.
d. If she does not want to start a statin, a bile acid sequestrant is the next
best choice for her.
e. Her 10-year ASCVD risk should be calculated to determine if she needs a
high- or moderate-intensity statin.
The answer is E, but why are other answers incorrect?