A 45-Year-Old Man Comes to the Clinic for Follow-Up of Hypertension

A 45-year-old man comes to the clinic for follow-up of hypertension.  He was diagnosed 6 months ago and prescribed antihypertensive therapy.  The patient is an ex-smoker with a 25-pack-year history; he quit smoking 2 years ago.  Medical history includes a laparoscopic cholecystectomy 5 years ago after an episode of acute cholecystitis.  He eats a well-balanced diet, walks 2-3 miles daily, and does not consume alcohol.  His father had a heart attack at age 62, and his mother died of a stroke at age 67.  Blood pressure is 140/88 mm Hg and pulse is 67/min.  BMI is 30 kg/m².  Physical examination is unremarkable.  Fasting laboratory results are as follows: Which of the following is the best next step in management of this patient?

A)Calculate 10-year atherosclerotic cardiovascular disease risk
B)Lower triglycerides with fenofibrate
C)Obtain coronary artery calcium score
D)Start high-intensity statin therapy with rosuvastatin
E)Start metformin to assist with weight loss

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