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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
© Start aspirin alone
(D) Start statins

A.

d??

hard question but I think the answer is A.

D..

i wld go with d

i dont know for sure...maybe aspirin alone..has 1 risk factor:obesity: diet for more than 160 LDL, statins for LDL more than 190

DD

Target LDL in the presence of CAD is<100mg/dl.

positive stress test means he has CAD!!!

Answer:

(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.