What is the most appropriate next step for a woman with diabetes and an estimated ASCVD risk of 6.0%?

In considering the management of a woman with diabetes and an estimated Atherosclerotic Cardiovascular Disease (ASCVD) risk of 6.0%, starting a moderate-intensity statin is deemed the most appropriate next step. This recommendation aligns with established guidelines, which suggest that individuals with diabetes aged 40-75 years should generally be initiated on moderate-intensity statin therapy, as they are at increased risk of cardiovascular events.

Moderate-intensity statins effectively lower LDL cholesterol levels and also provide additional benefits in reducing cardiovascular risk, even when the estimated ASCVD risk is relatively moderate, such as 6.0% in this scenario. The presence of diabetes signifies a higher baseline risk for atherosclerotic cardiovascular events, prompting guidelines to recommend statin therapy even if the ASCVD risk is not exceedingly high.

While low-intensity statins could provide some benefit, they are typically not sufficient in this population due to the protective effects and robust LDL reduction associated with moderate-intensity therapy. High-intensity statins may be over-treatment for someone at this ASCVD risk, as they are generally recommended for individuals with a higher risk profile or existing cardiovascular disease. Lastly, relying solely on lifestyle modifications without pharmacotherapy does not align with the aggressive management