Primary Prevention of Atherosclerotic Cardiovascular Disease for Those at Intermediate Risk

A 55-year-old African American gentleman with no significant past medical history is seen in follow up. His cardiac review of systems is negative for chest discomfort or shortness of breath. He has had elevated blood pressures >130/80 on two prior clinic visits. There is no family history of premature coronary artery disease or sudden cardiac death. He engages in regular exercise, including resistance training for an hour each session 3 days a week and low-impact cardio for 20 minutes once a week. He has never used any tobacco products. Other than a daily multivitamin, he does not take any medications.

His blood pressure and pulse at the office visit are 139/80 mm Hg 70 beats per minute, respectively. He weighs 80 kg with a BMI of 24 kg/m2.

Recent lab work reveals the following:

  • Total cholesterol: 180 mg/dl
  • Triglycerides: 140 mg/dl
  • High-density lipoprotein-cholesterol (HDL-C): 32 mg/dl
  • Low-density lipoprotein-cholesterol (LDL-C) (calculated): 120 mg/dl
  • Hb A1c: 5.1%
  • Serum creatinine: 0.8 md/dL

Using the Pooled Cohort Risk Equations (PCE), his 10-year atherosclerotic cardiovascular disease (ASCVD) Risk is estimated to be 8.5%, placing him at intermediate risk for ASCVD risk according to the 2018 ACC/AHA Multi-Society Cholesterol Guideline. The clinician engages the patient in a detailed discussion regarding the risks and benefits of statin therapy. After some consideration, the patient declines statin therapy as he feels well overall and believes that he is healthy.

According to the 2018 ACC/AHA Multi-Society Cholesterol Guideline, what should the clinician recommend in addition to lifestyle modifications (i.e., healthy diet, daily exercise, smoking cessation)?

Show Answer