For a 57-year-old woman with diabetes and a 22% ASCVD risk score, what is the best recommendation regarding her lipid management?

In managing lipid levels for patients, particularly those with a significant ASCVD (Atherosclerotic Cardiovascular Disease) risk, the focus is on ensuring that lipid-lowering therapy is adequate to reduce cardiovascular risk. The patient's 22% ASCVD risk score combined with her diabetes indicates a need for stringent lipid management.

By increasing the atorvastatin dosage to 40 mg/day, the goal is to enhance LDL-C (low-density lipoprotein cholesterol) reduction. Atorvastatin is a statin that has been shown to significantly lower LDL levels and consequently decrease the incidence of cardiovascular events. The 2018 cholesterol treatment guidelines recommend high-intensity statin therapy for individuals with diabetes ages 40-75 years who have atherosclerotic cardiovascular disease (ASCVD) risk of 20% or greater. Increasing atorvastatin to 40 mg/day aligns well with this recommendation and addresses her high-risk status effectively.

The alternatives such as fenofibrate or niacin are not first-line agents for lipid management in this context. Fenofibrate is usually considered in situations where there are very high triglyceride levels, and niacin has fallen out of favor due to limited evidence of cardiovascular benefit and potential side effects. Continuing the atorvastatin at