Clinical Case Database / Category: Case Based Discussion
Cardiovascular risk factors
Publication details
Dr. Alistair Lindsay BSc (Hons.) MBChB MRCP
Foundation Years Journal, volume 1, issue 1, p.12 (123Doc Education, London, April 2007)
Abstract
You are asked to see a 43-years-old male patient who is due to be discharged following a successful hernia operation. He is very concerned about his health as his father died of a heart attack aged 51 years, however he continues to smoke 20 cigarettes a day. Blood pressure has been measured as 165/89, but the remainder of the clinical examination is normal. An ECG shows sinus rhythm at 80 bpm, with no abnormalities seen. Fasting blood tests reveal a total cholesterol of 6.3, with an LDL level of 3.9 and an HDL level of 0.8, and the patient’s fasting blood sugar is also slightly elevated at 6.5. He asks you what his chances of having a heart attack are and what can be done to minimise the risk – what do you tell him?
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Authors
Dr. Alistair Lindsay BSc (Hons.) MBChB MRCP
Cardiology Registrar
North West Thames
References
1. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L; INTERHEART Study Investigators. “Effect of potentially modifible risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study.†Lancet. 2004 Sep 11-17;364(9438):937-52
2. Stamler J, Wentworth D, Neaton JD. Is the relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the multiple risk factor intervention trial (MRFIT). JAMA 1986;256: 2827-8.
3. LaRosa JC, He J, Vupputuri S. Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA 1999;282: 2340-6.
4. McGuire DK, Rao SV, Joski PJ, et al. Diabetes is associated with a higher risk of death than is prior myocardial infarction in the setting of coronary disease: Results from the Duke cardiovascular database. Abstracts from the 51st Annual Scientifi Session; March 17-20, 2002; Atlanta, Georgia. Abstract 1172-44.
5. Edwards R. The problem of tobacco smoking. BMJ, Jan 2004; 328: 217-219 ; doi:10.1136/bmj.328.7433.217.
6. Rigotti NA, Thorndike AN, Regan S, et al. Bupropion for Smokers Hospitalized with Acute Cardiovascular Disease. American Journal of Medicine Volume 119, Issue 12, December 2006, Pages 1080-1087.
7. Wang TJ, Gona P, Larson MG et al. Multiple Biomarkers for the Prediction of First Major Cardiovascular Events and Death. New England Journal of Medicine December 2006, Volume 355:2631-2639
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About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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