The Correct Answer is B!

 

A 66 year-old woman had an NSTEMI 2 weeks ago treated with a DES to the LAD with a pre-dismissal EF of 66%. She has been pain-free since discharge and was released on a beta blocker, high-intensity statin, and dual antiplatelet therapy. Her only medication on admission was metformin for type II DM, which was continued. Currently, her BP is 128/70 mmHg, her resting heart rate is 58 bpm, and she has normal renal function. She is tolerating all of her medications well. Lipids on admission prior to starting statin therapy showed a total cholesterol of 250 mg/dL, triglycerides of 220 mg/dL, an HDL of 38 mg/dL, and an LDL of 168 mg/dL.

What other medication should be started now?

A. Fenofibrate 145 mg daily
B. Lisinopril 5 mg daily
C. Spironolactone 25 mg daily
D. Ezetimibe 10 mg daily

Rationale:

ACE inhibitors should be prescribed in all patients with SIHD who also have hypertension, diabetes mellitus, LV ejection fraction 40% or less, or chronic kidney disease, unless contraindicated. Fibrates are not indicated in patients with mild hypertriglyceridemia and may increase the risk of muscle toxicity in patients on statins. Non-statin medications, such as ezetimibe, could be considered if the patient has a suboptimal response to statin therapy or does not meet goal lipid levels. However, the patient’s response to statin therapy must be reassessed 4-12 weeks after starting statin therapy before determining the appropriateness of ezetimibe. Aldosterone antagonists such as spironolactone are not indicated in normotensive patients with preserved left ventricular systolic function.

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