A 56-year-old man is diagnosed with the metabolic syndrome, which consists of hypertension, insulin resistance, dyslipidemia, and abdominal obesity. He has no prior history of cardiac or vascular disease and is otherwise well. His fasting T-chol is 270 mg/dL, HDL 50 mg/dL, LDL 150 mg/dL, and triglycerides 150 mg/dL. His Framingham risk calculation approximates a 10- year risk for cardiac events of 10%-20%.For the above patient with dyslipidemia, select the most appropriate treatment.

The metabolic syndrome is frequently identified among individuals given the increasing rates of obesity and diabetes in Western society. This individual has multiple atherogenic risk factors (obesity, hypertension, increased LDL) and his 10-year risk for cardiac events is approximated at 10%-20% by the risk calculator. At this risk level, the LDL goal is < 130 mg/dL and treatment threshold for starting drug therapy is > 130 mg/dL. Lifestyle modification too is an important component of the overall treatment.