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A 58-year-old woman comes to the office for an annual health maintenance examination. She has type 2 diabetes mellitus and is obese with a waist-hip ratio greater than 0.85. She is physically inactive and smokes cigarettes. She has had multiple pregnancies but is now postmenopausal and is not taking estrogen replacement therapy. Her blood pressure is 166/98 mm Hg; serum total cholesterol concentration is 261 mg/dL, with an HDL concentration of 34 mg/dL. In counseling her regarding her risk for coronary artery disease, you explain that her risk factors can be classified into major and minor modifiable risk factors. You should tell her that her greatest major modifiable risk factor is which of the following?
A
)
Blood pressure
B
)
Central obesity
C
)
Cigarette smoking
D
)
Physical inactivity
E
)
Type 2 diabetes mellitus
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B)..Weight reduction decreases the BP, dec the cholestrol ,increases HDL..so major modifiable factor
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nope not b, answer is c (confirmed by nbme for step 3) but wanted to get your thoughts about why not E, DM is a cad equivalent so why wouldn't it be the number one modifiable risk factor?
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As far as I know, the risk factors for CHD from strongest to weakest are:
1. Smoking
2. DM
3. HTN
4. Abdominal obesity
For physical activity, the protective effect is very mild. If Smoking raises your chance of CHD by 3, exercise lowers that to maybe 2.9.
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The key word is MODIFIABLE Smoking provides a measurable decrease in CAD risk like none other.. DM can be controlled but not reversed, remember glycemic control has no effect on MACROVASCULAR complications of DM CAD is a macrovascular cx
Decreasing central obesity will help but not as much for CAD it would help with DM and insulin resistance more than CAD
