This is a clinical scenario drawn from my own practice. I'll tell you what I plan to do, but I'm most interested in crowdsourcing a response from all of you to collectively determine best practice. So please answer the polling question and contribute your thoughts in the comments, whether you agree or disagree.
The Patient
You are seeing a 58-year-old woman for a routine visit for chronic disease management. She has a 15-year history of poorly-controlled hypertension. She also has chronic kidney disease stage 3aA2, obesity, prediabetes, hyperlipidemia, and menopausal symptoms. She has no known cardiovascular disease. Furthermore, she has no symptoms today and reports taking her medications as scheduled.
The patient's medications include lovastatin 40 mg nightly, lisinopril 10 mg daily, hydrochlorothiazide 25 mg daily, metoprolol XL 50 mg daily, aspirin 81 mg daily, and an estradiol transdermal patch replaced weekly.
Today, her blood pressure is 166/89 mm Hg, which is slightly higher compared with her readings at home, which feature a systolic blood pressure of 150-159 mm Hg. Her physical examination is otherwise unremarkable.
Lab results are notable for an A1c of 6.3%, which is stable from her last measurement 10 months ago. A chemistry panel is normal except for a serum creatinine of 1.3 mg/dL and an estimated glomerular filtration rate of 52 mL/min/1.73 m2, which is slightly worse compared with 4 months ago. Her urine albumin-to-creatinine ratio is 62 mg/g.
The patient's lipid profile is:
Total cholesterol: 170 mg/dL
Low-density lipoprotein cholesterol (LDL-C): 97 mg/dL
High-density lipoprotein cholesterol (HDL-C): 35 mg/dL
Triglycerides: 198 mg/dL
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Cite this: Dyslipidemia: What Would You Do? - Medscape - Jun 27, 2023.
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