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.

Cardiovascular tests
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.

References

1. 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

< Back to Listings