A 52-Year-Old Man With Atherosclerosis

A 52-year-old executive was referred to our clinic for risk factor management after undergoing coronary computed tomography angiography (CTA) as part of an Executive Physical. He has no history of coronary artery disease and exercises regularly without experiencing anginal symptoms.

His family history is notable for a myocardial infarction (MI) in his father at the age of 52 years. He is a lifelong non-smoker. He does not take medications.

His blood pressure was 110/75. His exam was notable for being overweight with a BMI of 27, but was otherwise unremarkable.

His total cholesterol is 206 mg/dL, HDL-C is 46 mg/dL, triglycerides are 178 mg/dL, calculated LDL-C is 124 mg/dL, and non HDL-C is 160 mg/dL. His fasting glucose is 86 mg/dL. His Hgb A1c is 5.6%.

His 10-year risk based on the 2013 ACC/AHA pooled ASCVD risk estimator is 3.7%.

His coronary artery calcium (CAC) score is 120, which places him in the 87th percentile for his age, gender, and ethnicity.

His coronary CTA shows the following in the proximal LAD:

Figure 1

In addition to maximizing therapeutic lifestyle changes (exercise, weight loss), what is the next step in this patient’s management?

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