A 44-year-old white woman treated for hypertension presents for advice on lipid treatment. She smokes but is not diabetic and has no history of cardiovascular disease. Blood pressure is 134/72 mm Hg and body mass index is 36.0. Fasting lipids reveal total cholesterol 203 mg/dL, low-density-lipoprotein cholesterol (LDL-C) 95 mg/dL, triglycerides 350 mg/dL, and high-density-lipoprotein cholesterol (HDL-C) 38 mg/dL. Based on the Pooled Cohort Risk Assessment Equations, this patient's 10-year atherosclerotic cardiovascular disease risk is 7.3%. Her lifetime risk is 50%, or 6 times that of a 50-year-old white woman with optimal risk factors. Her 10-year risk would not suggest treatment, but her lifetime risk is concerning. In addition to smoking cessation, improved diet, and routine exercise, a more in-depth discussion about statin therapy and possible ancillary testing such as coronary artery calcium scoring or high-sensitivity C-reactive protein (hs-CRP) to further stratify her risk may be warranted.
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Published online: February 24, 2014
Conflicts of Interest: None.
Authorship: All authors had access to the data and participated in the writing of the manuscript.
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Getting Lost Among the Guidelines: The Difference Between Patient-focused Treatment and Population ManagementThe American Journal of MedicineVol. 128Issue 10
- PreviewConstruction of a retaining wall around a blocked drain ignores the root cause of the problem. In much the same way, expecting a single 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor to reduce all-cause morbidity and mortality in the face of obesity, diabetes, cigarette addiction, hypertension, hypertriglyceridemia, and metabolic syndrome focuses on a marker of lifestyle choice and genetics but not on the root cause of the problem.