62 years old woman with a history of three vessel cronary artery bypass grafting 2 years earlier and diabetes completes her fasting laboratory work. Medications include simvastatin 80 mg/day, glipizide 5 mg two times/day, metoprolol SR 25 mg/day, and ASA 81 mg/day. During the past year, she has seen a steady decline in her renal function. Laboratory results show TC 143, TG 160, HDL-C 42, LDL 63, non–HDL-C 101, SCr 2.3, CrCl (IBW) 21.9 mL/minute, ALT 45, Na 144, K 4.9, and A1C 7.5%. She weighs 81 kg and is 5′4′′ tall. Which is the best recommendation for this patien?
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