A 54-Year-Old Man With "Optimal" LDL-C and a Family History of Coronary Heart Disease: Assessing CV Risk Beyond Low Density Lipoprotein Cholesterol

History of Presenting Illness

A 54-year-old white accountant presents to cardiology clinic to establish care. He denies chest pain, shortness of breath, dyspnea on exertion, palpitations, syncope or presyncope. Several male members in his family had suffered premature cardiovascular events. He exercises two to four times a week. He has been tolerating his prescription medications well and reports no side effects. Recently his 56-year-old first cousin suffered a massive heart attack and this got him concerned regarding his "cardiovascular risk."

He is a non-smoker and drinks one glass of red wine daily. His father had his first heart attack at age 54 and his first male cousin, age 56, had a recent heart attack and coronary artery bypass grafting. He was commenced on Atorvastatin 20 mg daily by his primary care physician a few weeks ago and he also takes one multivitamin pill daily. Physical exam was significant for a blood pressure of 122/76mmHg, body mass index of 28 kg/m2, and a waist circumference of 40 inches.

Laboratory Data

Complete blood count and basic metabolic panel are within normal limits. TC: 198 mg/dL
HDL-C: 38 mg/dL
LDL-C: 115 mg/dL
TGs – 225 mg/dl
FBG: 91 mg/dL
TSH: Normal
ALT and AST: Normal


Normal sinus rhythm with no abnormality

All the following additional laboratory tests are reasonable and can help guide further management of his cardiovascular risk except:

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