Poll: Another Role for Calcium Score?
Mr. L is a 73-year-old male who presents for a routine follow up with his cardiologist1 and reports no symptoms. During the clinic visit, he stated he is not interested in starting any new medications and would like to consider discontinuing some medications.
Cardiovascular comorbidities: Paroxysmal atrial fibrillation, hypertension.
Pertinent negative history: He has not had a prior coronary event (no history of acute coronary syndrome or coronary revascularization).
Non-cardiovascular comorbidities: History of basal skin cancer.
Medications: dabigatran 150-mg twice daily, aspirin 81 mg daily, metoprolol XL 25 mg daily, atorvastatin 10 mg daily
Physical Exam: He is thin and in no acute distress. His BP is 130/76 mmHg, the heart rate is 83 bpm. His cardiovascular exam revealed a regular rhythm with no murmurs, lungs were clear to auscultation and neurologic exam was normal.
His most recent fasting lipid laboratory tests revealed: Total Cholesterol 107 mg/dL, LDL-C 25 mg/dL, HDL-C 56 mg/dL and Triglycerides 132 mg/dL.
Prior Lipids: TC 130 mg/dL, LDL-C 30 mg/dL, HDL-C 49 mg/dL, Triglycerides: 254 mg/dL.
Electrocardiogram (ECG): Normal sinus rhythm, no ST-T changes, occasional premature ventricular contractions (PVCs).
Echocardiogram: Normal left ventricular dimensions and systolic function without focal wall motion abnormalities. Estimated ejection fraction 55-60%, No significant valvular or structural abnormalities.
- Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary. a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019;74:1376-1414.
Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Geriatric Cardiology, Prevention, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Hypertension
Keywords: Aged, Atorvastatin, Cholesterol, LDL, Calcium, Dabigatran, Metoprolol, Follow-Up Studies, Atrial Fibrillation, Coronary Vessels, Deprescriptions, Heart Rate, Stroke Volume, Ventricular Premature Complexes, Triglycerides, Hypertension, Risk Assessment, Electrocardiography, Auscultation, Ambulatory Care, Aspirin, Primary Prevention
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