CV Risk Management of a Young Asymptomatic Adult With a “High-Risk Lifestyle” | Patient Case Quiz

A 40-year-old Caucasian man presents to your preventive cardiology clinic. He has no personal history of cardiovascular disease (CVD), is asymptomatic, and is not taking any medications. His parents are both alive and free from CVD, diabetes, or lipid disorders. He started smoking five to 10 cigarettes per day at age 14 and currently smokes 10 to 20 cigarettes per day. He has thought about giving up smoking several times, but never tried it seriously.

He has worked in the same office for 15 years, with growing levels of responsibility. This resulted in increasing daily time devoted to work, quick meals, and reduced leisure time, especially after his divorce. Every morning he likes to have a copious breakfast often including eggs, bacon and/or sausages, cookies, and a cup of coffee with cream. For lunch he eats a meal delivered by a local restaurant at his office desk, and for dinner he tends to eat homemade pasta or a sandwich. On Saturdays, he works at home following a similar dietary pattern, and on Sundays, he likes to relax with friends having dinner at a restaurant or watching a game of their favorite teams while having a pizza. Because of his job, he spends long periods of time sitting, and his engagement in leisure-time physical activities had diminished progressively. He sleeps about five hours a night. In this context, he reports having gained about 22 pounds in the last five years.

It is after one of his friends had a myocardial infarction at age 42 that he decides to present to your clinic concerned about his personal risk for having a myocardial infarction.

On exam, blood pressure is 136/86 mm Hg, body mass index (BMI) 27.6 kg/m2, waist circumference 107 cm. The rest of the physical examination is normal. The laboratory studies show total cholesterol of 202 mg/dL, high-density lipoprotein cholesterol (HDL-C) 35 mg/dL, triglycerides 158 mg/dL, HbA1c 5.6%.

The patient's 10-year absolute atherosclerotic cardiovascular disease (ASCVD) risk according to the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) Pooled Cohort Equations is 7.0%.

In the context of CVD risk management, which of the following should always be part of your intervention in the absence of contraindication?

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