Diabetes & ASCVD Therapy — ABIM Board MCQ

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ModerateEndocrinology/CardiologyDiabetes & ASCVD TherapyABIM Board

A 66‑year‑old woman with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD) is on metformin and high‑intensity statin therapy. Her blood pressure is 130/72 mm Hg, LDL cholesterol is 68 mg/dL (target <55 mg/dL for very‑high‑risk ASCVD), triglycerides are 110 mg/dL, and there is no albuminuria. What is the recommended next pharmacological intervention for ASCVD risk reduction according to current ADA Standards?

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Correct answer: D — GLP‑1 receptor agonist with proven cardiovascular benefit

In patients with type 2 diabetes and established ASCVD, the ADA (2026) recommends initiating a GLP‑1 receptor agonist with proven cardiovascular benefit regardless of glycemic control or LDL levels (source 1). Although the LDL is slightly above the new secondary prevention target of <55 mg/dL, the more pressing evidence‑based intervention is cardioprotection via GLP‑1 RA. Icosapent ethyl is not appropriate since the patient’s triglycerides are not elevated (source 3). PCSK9 inhibition or ezetimibe (options A and E) address lipid levels but are less prioritized than GLP‑1 RA given the direct cardiovascular risk reduction benefit. ACE‑I/ARB (option C) are not indicated without albuminuria or hypertension beyond current control.

Reference: ADA Standards of Medical Care in Diabetes—2026: Pharmacologic Approaches to Glycemic Treatment; ACC/AHA 2026 Guideline for Managing Dyslipidemia, https://pmc.ncbi.nlm.nih.gov/articles/PMC12690185/