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CV Risk Management in a Patient with High BP and a Significant Family History

A 52-year-old Asian-American man presents for a wellness visit. He has borderline elevated blood pressure (136/84 mm Hg), a BMI of 27 kg/m2, and a family history of diabetes and myocardial infarction. He is a nonsmoker, drinks 1-2 glasses of wine nightly, and jogs 4-5 times/wk for 40 min. Total cholesterol is 173 mg/dL (high-density lipoprotein cholesterol, 40 mg/dL; low-density lipoprotein cholesterol, 112 mg/dL). His 10-y atherosclerotic cardiovascular disease risk is 7.5%, and takes no medications. According to the 2013 American College of Cardiology/American Heart Association cholesterol guidelines, what's the first step you should take with this patient?

Correct

Answer: D. None of the above

Explanation:  According to the 2013 American College of Cardiology/American Heart Association cholesterol guidelines, the next best step is to initiate a clinician-patient risk discussion to weigh the risk reduction benefits against the potential adverse effects that may occur when starting preventive statin therapy or ordering additional testing. The guidelines emphasize the importance of patient preferences and shared decision-making between the clinician and the patient. For a patient with an atherosclerotic cardiovascular disease risk ?7.5%, the recommendation is to initiate a moderate- to high-intensity statin after a risk discussion.

Stone NJ, et al. J Am Coll Cardiol. 2014;63(25):2889-2934.  55 yo M w/ Elevated BP: Is Coronary Artery Calcium Scoring Appropriate?   http://quantiamd.com/player/yjmbnywfg?cid=10000076   Stone NJ, et al. J Am Coll Cardiol. 2014;63(25):2889-2934.

Incorrect