assignment

A 56 year-old man comes into your office for a routine health maintenance visit.  He is new to your practice and has no specific complaints today.  He has hypertension (HTN) for which he takes Hydrochlorothiazide 50mg daily, and he occasionally takes a baby aspirin because someone told him that it was good for him.  He does not smoke cigarettes, he drinks 4 beers daily, and does not exercise.  His father died of a heart attack (MI) at the age of 60 and his mother died at the age of 72 of cancer.  He has two younger sisters who are in good health.  On examination, his blood pressure is 130/80 mm Hg and his pulse is 75 BPM.  He is 6ft tall and weighs 200 pounds.  His complete physical examination is normal.  You order routine annual labs which return with the following results:  Total cholesterol 242 mg/dL; triglycerides 138 mg/dL; high-density lipoprotein (HDL) cholesterol 38 mg/dL; and low-density lipoprotein (LDL) cholesterol 168 mg/dL.

1. Using this information, calculate his 10-year CVD risk using two different risk calculators.
2. Are there any additional exam findings, elements of the patient’s history, or additional laboratory findings that you would want as it relates to his cardiac risk (using your Bate’s text chapter 9)?
3. In this case study, what do you see as his risk factors for cardiovascular disease?
4. Using your Bate’s text (chapter 9) and the Up to Date article titled “Overview of primary prevention of coronary heart disease and stroke” what are some specific recommendations you would give this patient to decrease his risk of CVD (list at least 4)?