Cardiovascular disease prevention in a newly diagnosed diabetic patient

Case scenario

My patient, Mark, is 53 years old and was diagnosed with type 2 diabetes six months ago. His blood sugar was not controlled well with diet and lifestyle modification, and he now takes metformin. He is not happy about needing medication.

Despite his lifestyle changes, both his LDL-cholesterol level and systolic blood pressure are above recommended guidelines, but only just. He has an LDL-cholesterol level of 3.5 mmol/L, an HDL-cholesterol level of 1.2 mmol/L and a borderline blood pressure (measured on two separate occasions) of 135/75 mmHg; he has no proteinuria. Is it unquestionably time to start drug therapy to treat Mark’s dyslipidaemia and blood pressure, and should he be taking aspirin?