risk factors for CAD - kj72patel

[ArchivalUser]

12. An overweight 60 year old white male comes to your office for an early appointment to know about his cholesterol and heart disease risks. He is a diabetic for the past 25 years, smokes 1 packet per day for the past 20 years, has mild hypertension and is on a betablocker for that. His elder brother died at the age of 52 suddenly. His father had a stroke at the age of 72 and died later.
You send for his fasting lipid profile. You discuss with him the ways how heart disease risk is calculated.When telling him about his coronary artery disease risks,
Which of the following IS NOT A RISK FACTOR for CAD?
a. Hypertension
b. Smoking
c. Brother dying of probable myocardial infarction at 52
d. Diabetes Mellitus
e.His lipid profile showing a Low HDL level
f. His age

[ArchivalUser]

F//

[ArchivalUser]

C?

[ArchivalUser]

b2, for +ve family history, cutoff age is 55, if his brother would have died at age 55 than would not be considered +ve family history.

Now his age (which is now 60years, is not a risk factor) really not sure, but all other choices seems to be good risk factor, so will join jama for (f)

[ArchivalUser]

hmm... dunno abt the cutoff age for family hx, but age, without a doubt, is a major non-modifiable risk factor for CAD. will try and confirm about that age thing, or if kj has the explanation then that'd be even better ;-)

[ArchivalUser]

age > 45 for men
or > 55 for women [or postmenopausal state without estrogen replacement],
high BP,
smoking,
diabetes,
HDL < 35 mg/dL,
family history of CAD before age 55 in a M or before age 65 in a F first-degree relative.

This evaluation should include fasting levels of TC, triglyceride, and HDL.
LDL is then calculated by applying the following formula:
LDL cholesterol = TC - HDL cholesterol - triglyceride/5.
(This formula is valid only when triglyceride is < 400 mg/dL (< 4.52 mmol/dL).
A high HDL level (> 60 mg/dL (> 1.55 mmol/dL) is considered a negative risk factor and reduces the number of risk factors by one.
The NCEP recommends that treatment decisions be based on the calculated level of LDL For patients with an elevated LDL ( 160 mg/dL ( 4.14 mmol/dL) who have fewer than two risk factors in addition to elevated LDL and who do not have clinical evidence of atherosclerotic disease, the goal of treatment is an LDL level < 160 mg/dL. For those who have at least two other risk factors, the goal of treatment is an LDL level < 130 mg/dL (< 3.37 mmol/dL). When LDL levels remain > 160 mg/dL despite dietary measures and the patient has two or more risk factors (in addition to high LDL), or when LDL levels remain > 190 mg/dL (> 4.92 mmol/dL) even without added risk factors, the addition of drug treatment should be considered. For those with CAD, peripheral vascular disease, or cerebrovascular disease, the goal of treatment is an LDL < 100 mg/dL (< 2.59 mmol/dL). All patients with clinical evidence of coronary or other atherosclerotic disease should be evaluated with a fasting blood sample for measurement of TC, triglyceride, and HDL. LDL is again calculated, as described above. In contrast to plasma TC, it is unclear whether plasma triglycerides are independent risk variables; like TC, they vary with age. A triglyceride level of < 200 mg/dL (< 2.26 mmol/dL) is considered normal, 200 to 400 mg/dL (2.26 to 4.52 mmol/dL) is borderline high, and > 400 mg/dL (> 4.52 mmol/dL) is high. Hypertriglyceridemia has been associated with diabetes, hyperuricemia, and pancreatitis (when levels are > 600 mg/dL).

IN OUR PATIENT ALL ARE THERE BUT WE DONT KNOW WHETHER BROTHER REALLY HAD CAD AND WHAT IS HIS LDL.
ACTUALLY ALL ARE TRUE.

[ArchivalUser]

I saw this recall before. Q was originally that "which of the following is the most important risk factor for CAD?

In fact, they are all risk factors for CAD.

[ArchivalUser]

yes this is recall question
and they gave ans as DM, stating that DM is not a risk factor but DM=== CAD
that's their explaination