A 49-year-old woman comes to the office to discuss her risk of heart disease. Her husband recently died of an acute myocardial infarction, and she says, "I need to take care of myself so I can be there for my kids." The patient's medical history is unremarkable and she takes no medications. Her mother died of dementia at age 76, and her father died of chronic obstructive pulmonary disease at age 68. She has a 30-pack-year smoking history but quit after her husband's heart attack, and she drinks a can of beer every day. The patient has a sedentary occupation and does not engage in regular exercise.
Blood pressure is 129/79 mm Hg and pulse is 80/min. BMI is 32 kg/m². Physical examination shows central obesity but is otherwise unremarkable.
Laboratory results are as follows:
In addition to providing guidance on increasing physical activity, which of the following is the most appropriate recommendation to reduce the risk of cardiovascular disease in this patient?

Question

A 49-year-old woman comes to the office to discuss her risk of heart disease. Her husband recently died of an acute myocardial infarction, and she says, "I need to take care of myself so I can be there for my kids." The patient's medical history is unremarkable and she takes no medications. Her mother died of dementia at age 76, and her father died of chronic obstructive pulmonary disease at age 68. She has a 30-pack-year smoking history but quit after her husband's heart attack, and she drinks a can of beer every day. The patient has a sedentary occupation and does not engage in regular exercise.
Blood pressure is 129/79 mm Hg and pulse is 80/min. BMI is 32 kg/m². Physical examination shows central obesity but is otherwise unremarkable.
Laboratory results are as follows:

In addition to providing guidance on increasing physical activity, which of the following is the most appropriate recommendation to reduce the risk of cardiovascular disease in this patient?

Quizplus · Accepted Answer

11ec193a_9775_5826_853d_b1e1b8fbdb22_MD0002_00 This patient has quit smoking, which, if sustained, is associated with a reduced risk of heart disease. However, she also has mild obesity, elevated blood pressure, hyperglycemia, and suboptimal lipid values, all of which are likely to worsen with age and increase her cardiovascular risk. These risk factors do not require medication at this time, but the patient would benefit from changes in lifestyle to address them now. The Mediterranean-style diet emphasizes plant-based foods (eg, fruits, vegetables, whole grains, nuts), olive oil (in place of butter), fish and poultry (in place of red meat), and moderate salt intake. Studies have found reductions in the risk of cardiac events and cardiovascular mortality with the Mediterranean diet compared with a conventional diet. Alternately, the similar Dietary Approaches to Stop Hypertension (DASH) diet has been shown to lower blood pressure and can reduce the risk of cardiovascular disease. Either of these dietary interventions would be appropriate for this patient. (Choice A) Diets high in antioxidant-containing foods (eg, DASH diet, Mediterranean diet) are associated with a lower risk of coronary events. However, randomized trials of antioxidant supplements have consistently shown no benefit in preventing coronary events. (Choice B) Heavy alcohol intake (>4 drinks/day for men, >2 drinks/day for women) is associated with an increased risk of heart failure. However, this patient's moderate alcohol intake has minimal impact on her risk of heart failure and is associated with a slightly reduced overall cardiovascular risk. (Choice C) Both low-fat and low-carbohydrate diets are effective for weight loss, but evidence for reduced cardiac risk is weak. Patients who adhere to either the DASH diet or the Mediterranean diet frequently lose weight, and these programs are likely more effective for reducing cardiac risk. (Choice E) A moderate reduction in sodium intake may be helpful for some patients. However a very-low sodium diet (eg, <1,500 mg/day) is unlikely to benefit most individuals, is difficult to sustain, and is generally advised only for patients with uncontrolled hypertension. Educational objective: Lifestyle interventions that can reduce the risk of cardiovascular disease include regular physical exercise, a Mediterranean-style diet, the Dietary Approaches to Stop Hypertension (DASH) diet, smoking cessation, and moderate but not excessive alcohol intake. __________ References: Diet and physical activity for cardiovascular disease prevention. (http://www.ncbi.nlm.nih.gov/pubmed/27281836)

A 49-Year-Old Woman Comes to the Office to Discuss Her