Patient History A 59-year-old man with an 18-year history of diabetes mellitus is being treated with insulin glargine and metformin. He has had longstanding hypertension, hyperlipidemia, and renal insufficiency, but no previous heart attack or stroke. His review of systems is negative. He stopped smoking cigarettes 2 years ago. He asks for recommendations to help him reduce his risk of a cardiovascular event.
Both his father and paternal uncle have diabetes and developed coronary artery disease requiring stenting. Physical Examination Blood pressure = 138/82 mm Hg Pulse rate = 88 beats/min BMI = 32.1 kg/m2 Eye examination- Bilateral retinal microaneurysms Cardiac examination- The patient has a regular rate and rhythm, a loud S4, no S3, and no murmurs. There are no carotid bruits. His abdomen is obese with no striae or renal bruits Neurologic examination- There is symmetric decreased…