doc_clotaire
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A 43-year-old obese man is referred to you by his corporate masters for a cardiac evaluation prior to beginning an exercise program that mostly consists of playing intense games of racquetball with the boss. He denies any cardiac risk factors and has no history of coronary disease. His parents are robustly healthy, and he does not smoke. You find a blood pressure of 110/70 mg/dL. Laboratory tests show an LDL of only 140 mg/dL. His EKG is normal. In order to clear him for exercise, you order a thallium stress test, which shows a small reversible defect in his inferior wall. How would you manage him
(A) Clear him for racquetball
(B) Tell him he will have no problem as long as he loses 10% of body weight prior to beginning exercise
(C) Start aspirin alone
(D) Start statins
(E) Lifestyle modification
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| Justice
Forum Fanatic
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(C) Start aspirin alone???
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| new_n_lost
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(E) Lifestyle modification ??
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| mytime
Kick my butt!
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e
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| Adam
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his LDL is not very high and i think of (E). BUT i wonder , that defect in the inferior wall, is it an indication to start with statin ??
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| neuroblastoma
Forum Guru
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I think D---Because (( CAD + LDL 140 +obesity risk factor--))- give STATINS???
small reversible defect in his inferior wall--means ISCHEMIA IN walls of heart due to coronary prob.(CAD)????
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| NE
Forum Guru
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"Small reversible defect in his inferior wall" means CAD. The goal is LDL<100 and if he would have LDL<130- lifestyle modification ; he has LDL >130 so I would go with statins.
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| doc_clotaire
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(D) Start statins
Explanation:
Although he has no cardiac risk factors, he has an LDL above 130 and a sestress test showing ischemia. Once you have the presence of coronary disease, risk factors such as hypertension, tobacco smoking, low HDL, family history, and the patient's age become irrelevant. Although obesity is certainly a risk for an increase in all-cause mortality, obesity is not specifically a risk factor in the evaluation of who needs lipid-lowering therapy. Statin therapy would be combined with a dietary restriction on fat intake, as well as weight loss.
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