Which Change in Therapy to Reduce CV Endpoints in T2DM?

July 3, 2014

You have reduced this patient's A1C to 6.9% by adding insulin. Suboptimal lipids and persistent hypertension now must be addressed. What change(s) would you make to her regimen?

A 68-year-old woman with a history of type 2 diabetes mellitus (T2DM), dyslipidemia, and hypertension presents to your clinic for routine follow-up. She is currently taking simvastatin 20 mg, hydrochlorothiazide 25 mg, metformin 1000 mg twice daily, and insulin, which you had added to her medical regimen at her last visit because of persistently difficult-to-control blood sugars. Repeat HbA1c at today’s visit is 6.9%.

Urinalysis shows no evidence of microalbuminuria and her most recent fasting lipid panel shows: total cholesterol, 150 mg/dL; HDL-C, 42 mg/dL; and LDL-C, 88 mg/dL. Vitals signs are: blood pressure, 148/69 mm Hg; and heart rate, 84 beats/min, in normal sinus rhythm. The remainder of her examination is unremarkable.

Which of the following medication changes is indicated and will reduce her risk of having a cardiovascular event in the future?