Case 2

Published on 02/03/2015 by admin

Filed under Internal Medicine

Last modified 03/03/2015

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Case 2

A 45-year-old man is urged by his wife to have a cardiac risk assessment. He has no cardiac symptoms.

His only coronary risk factor is dyslipidemia (LDL = 143 mg/dL, HDL = 35 mg/dL).

National Cholesterol Education Program (NCEP) Adult Treatment Panel III

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According to the NCEP Adult Treatment Panel III, he has two “non-LDL” risk factors. The next step is to determine his Framingham Risk Score (FRS).

Framingham Risk Score

Age: 45
Gender: Male
Total Cholesterol: 240 mg/dL
HDL Cholesterol: 35 mg/dL
Smoker: No
Systolic BP: 135 mm Hg
BP Medication: No
Risk Score: 6% over 10 years (low risk)

NCEP Adult Treatment Panel III

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Because his FRS is “low risk” and his target LDL is < 160 mg/dL, no treatment with cholesterol-lowering medications would be recommended. No other diagnostic testing is recommended.

Proposed Management Strategy for Asymptomatic Patients

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Because his FRS is “low risk,” the proposed treatment algorithm would suggest that he be managed according to primary prevention guidelines.

However, the patient’s wife requested that he have a coronary calcium score (CCS). According to published appropriateness criteria, CCS would be considered inappropriate (median score = 1) in this man with a low (<10% event rate over 10 years) FRS. However, at the urging of his wife, the CCS was obtained. (Refer to Hendel et al. J Am Coll Cardiol 48:1475–1497, 2006.)

Coronary Calcium Score

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Calcified plaque was detected in the LAD (137) and RCA (301), with a total CCS of 438 (>90th percentile for age and gender).

Clinical Questions

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