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)


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?

Access the Clinical Cases Database

A subscription is required to read the full article. Please subscribe using one of the options below.

Foundation Years Clinical Cases Database£29.006 months
Add to cart
Foundation Years Clinical Cases Database£39.0012 months
Add to cart


Dr. Alistair Lindsay BSc (Hons.) MBChB MRCP

Cardiology Registrar
North West Thames


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


Conflict Of Interest

The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (

Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts ( The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

Animal & Human Rights

When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

About the Clinical Cases Database

T​he 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.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.