A 50-year-old man comes to the physician for a routine check-up. He has a 20-pack-year smoking history and consumes alcohol occasionally. He eats a balanced diet and consumes fried foods and red meat several times a week. He is not very active and spends much of his free time watching television and sitting at his computer. His family history is significant for hypertension in his mother and bladder cancer in his father. His blood pressure is 160/90 mm Hg and heart rate is 70/min. Laboratory testing is significant for a fasting blood glucose level of 155 mg/dL. Which of the following interventions is likely to have the greatest effect on reducing this patient's mortality risk?

Question

A 50-year-old man comes to the physician for a routine check-up.  He has a 20-pack-year smoking history and consumes alcohol occasionally.  He eats a balanced diet and consumes fried foods and red meat several times a week.  He is not very active and spends much of his free time watching television and sitting at his computer.  His family history is significant for hypertension in his mother and bladder cancer in his father.  His blood pressure is 160/90 mm Hg and heart rate is 70/min.  Laboratory testing is significant for a fasting blood glucose level of 155 mg/dL.  Which of the following interventions is likely to have the greatest effect on reducing this patient's mortality risk?

Quizplus · Accepted Answer

11ec160b_3733_41c9_9249_7d55011f50f2_MD0001_00 One of the objectives for the national Healthy People 2020 initiative is to reduce the prevalence of tobacco smoking in adults from 20% in 2008 to less than 12% by 2020. Tobacco use, especially smoking, is the single most preventable cause of death and disease in the United States. In addition to its numerous direct adverse effects, tobacco smoking also substantially increases the risk for macrovascular (eg, myocardial infarction [MI], stroke) and microvascular (eg, retinopathy, nephropathy) complications of diabetes mellitus. These complications significantly increase mortality, primarily by increasing the risk of MI. The risk of MI-associated mortality begins to decrease immediately upon smoking cessation. However, it takes several tobacco-free years before the risk returns to baseline, especially in patients with a long history of smoking. In addition, smokers with diabetes have a higher likelihood of developing hypercholesterolemia, poor glycemic control, and end-stage renal disease. It appears that smoking not only worsens the complications of diabetes but also increases the likelihood of developing diabetes in the first place, thus highlighting the importance of prevention and early cessation. (Choice A) Fecal occult blood testing screens for colorectal cancer and improves mortality through earlier detection. Even so, the mortality benefit is much lower than that achieved by smoking cessation. (Choice B) Prostate-specific antigen is increased in some patients with prostate cancer. However, annual prostate-specific antigen testing has not been shown to improve mortality from prostate cancer. (Choice C) Aspirin use significantly reduces the risk of death from coronary heart disease in diabetic patients, at levels similar to smoking cessation. However, when all-cause mortality is compared, smoking cessation has a greater effect on reducing mortality than daily aspirin therapy. (Choices D, E, and G) Dietary modification and exercise reduce the risk of cardiovascular disease (to a lesser extent than smoking cessation) and help improve glycemic control in diabetic individuals. Although tight glycemic control has been shown to reduce the risk of microvascular complications from diabetes, it does not significantly improve cardiovascular or all-cause mortality. Educational objective: Smoking cessation is by far the most effective preventive intervention in almost all patients, and this is especially true in those with diabetes. __________ References: How can we best prolong life? Benefits of coronary risk factor reduction in non-diabetic and diabetic subjects. (http://www.ncbi.nlm.nih.gov/pubmed/8518573) Effect of tight blood glucose control versus conventional control in patients with type 2 diabetes mellitus: a systematic review with meta-analysis of randomized controlled trials. (http://www.ncbi.nlm.nih.gov/pubmed/22212499)

A 50-Year-Old Man Comes to the Physician for a Routine