A 46-year-old man comes to the office for a routine health maintenance visit. He has no medical conditions. The patient smokes a pack of cigarettes daily and does not drink alcohol. His mother has hypertension, and his father died of prostate cancer at age 70. Blood pressure is 128/76 mm Hg and pulse is 80/min. BMI is 29 kg/m². Laboratory results are as follows: The patient's calculated 10-year risk of atherosclerotic cardiovascular disease is 10.5%. Smoking cessation counseling and recommendations for diet, weight loss, and exercise are provided. Which of the following is the most appropriate next step in the management of this patient's cardiovascular risk?

Question

A 46-year-old man comes to the office for a routine health maintenance visit. He has no medical conditions. The patient smokes a pack of cigarettes daily and does not drink alcohol. His mother has hypertension, and his father died of prostate cancer at age 70. Blood pressure is 128/76 mm Hg and pulse is 80/min. BMI is 29 kg/m². Laboratory results are as follows: The patient's calculated 10-year risk of atherosclerotic cardiovascular disease is 10.5%. Smoking cessation counseling and recommendations for diet, weight loss, and exercise are provided. Which of the following is the most appropriate next step in the management of this patient's cardiovascular risk?

Quizplus · Accepted Answer

11ec25c8_d242_25f2_bc81_759556d88721_MD0003_00 This patient has several risk factors for atherosclerotic cardiovascular disease (ASCVD), including smoking, hyperlipidemia, age, and male sex. In such patients, the estimated 10-year ASCVD risk should be calculated using the Pooled Cohort Equations cardiovascular risk calculator. Patients with an estimated 10-year ASCVD risk >7.5%-10% (guidelines vary on the exact cutoff) should be initiated on statin therapy for primary prevention of ASCVD. If tolerated, atorvastatin or rosuvastatin is usually preferred because of a relatively higher potency than other statins (eg, simvastatin, pravastatin). calculator Statin therapy is also recommended for primary prevention of ASCVD in patients with LDL ≥190 mg/dL (which is suggestive of familial hypercholesterolemia) and those age ≥40 with diabetes mellitus, regardless of calculated ASCVD risk. Patients with established ASCVD (eg, history of acute coronary syndrome) should be on statin therapy for secondary prevention. (Choice A) Smoking cessation and lifestyle modifications (eg, healthy diet, weight loss, aerobic exercise) are appropriate to reduce cardiovascular risk in all patients. However, statin therapy is also indicated in this patient with an estimated 10-year ASCVD risk >7.5%-10%. (Choices B and D) Niacin is effective in raising HDL levels and reducing LDL levels, and fish oil containing omega-3 polyunsaturated fatty acids is effective in reducing serum triglyceride levels. However, despite the favorable effects of these agents on lipid profile, neither agent has demonstrated consistent benefit in cardiovascular disease prevention and outcomes. Statins have a greater proven benefit and are first-line therapy in both secondary and primary prevention of ASCVD. (Choice E) Low-dose aspirin (eg, 81 mg daily) is indicated for secondary prevention in patients with established ASCVD and also for primary prevention of ASCVD in high-risk patients age 50-70. However, it is not typically indicated for primary prevention in patients age <50 because the protective cardiovascular benefit may be too small to outweigh the increased risk of bleeding. Educational objective: Statin therapy is indicated for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in patients with an estimated 10-year ASCVD risk >7.5%-10% based on the Pooled Cohort Equations cardiovascular risk calculator. References: 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. (http://www.ncbi.nlm.nih.gov/pubmed/30879355) Comparative benefits of statins in the primary and secondary prevention of major coronary events and all-cause mortality: a network meta-analysis of placebo-controlled and active-comparator trials. (http://www.ncbi.nlm.nih.gov/pubmed/23447425)

A 46-Year-Old Man Comes to the Office for a Routine