Geriatric Syndromes and the Older Adult With Cardiovascular Disease: Cognitive Decline

A 70-year-old man has a history of inferior myocardial infarction at age 57 years, percutaneous coronary intervention, type 2 diabetes mellitus, and hypertension. He comes to the clinic for routine follow-up. His mother recently died at the age of 90 years after a long battle with dementia. Today, he wants to know what he can do to decrease his risk of developing dementia.

He denies any chest pain, shortness of breath, or palpitations with activity, although the most exercise he gets in a day includes walking up the five steps in his home, as well as walking across a parking lot or around the grocery store. He lives alone and does not enjoy cooking; therefore, he frequently eats frozen dinners or fast food.

Current Medications:
Metoprolol succinate 50 mg po daily
Lisinopril 10 mg po daily
Metformin 500 mg po bid
Aspirin 81 mg po daily
Atorvastatin 40 mg po qhs

Physical Examination:
Vital Signs: Afebrile, heart rate 60 bpm in sinus rhythm, blood pressure (BP) 155/96 mm Hg, oxygen saturation of 95% on room air, body mass index is 31.
General: Obese man in no acute distress.
Cardiovascular: Regular rate and rhythm, no murmurs, rubs, or gallops; jugular venous pressure is normal.
Respiratory: Lungs are clear to auscultation bilaterally.
Abdomen: Obese, soft, non-tender, non-distended with normal active bowel sounds.
Extremities: No edema, warm, well perfused.

Other Data:
Hemoglobin A1c was 9% two months ago.
His last echocardiogram was one year ago and showed overall normal left ventricular systolic function with mild hypokinesis of the inferior wall.
His electrocardiogram today shows normal sinus rhythm, rate 60 bpm with no q waves, normal axis.

Which of the following statements describes the advice you should give him as his cardiologist?

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