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Lifestyle Issues in Cardiac Health

Followup and Lifestyle Changes

Mr. Fowler returns to see the physician a week later as recommended. He and his wife met with the dietitian the day before, and together the three of them decided on a low calorie, low fat diet with the goal of losing approximately a pound a week. His ultimate goal is to reduce his weight to the range of 175-180, which he considers feasible. He has started to walk leisurely around the neighborhood early in the morning. He has been able to walk approximately half a mile without any difficulty. He has decided to embark on a smoking cessation program and is interested in using bupropion.

The physician prescribes bupropion 150 mg a day, with instructions to wait at least a week before quitting. She also gives the patient reading material that describes behavior modification techniques to assist with smoking cessation and provides information about a local smoking cessation counseling program. The physician emphasizes that the effort at smoking cessation should be undertaken at a time when there is not a lot of other stress and changes in life. The patient reports that the near future is a good time for this.

The physician then discusses the results of the fasting blood tests: The fasting serum glucose is 114 mg/dL. The fasting lipid profile is:

Total cholesterol: 225 mg/dL
Triglycerides: 180 mg/dL
LDL cholesterol: 155 mg/dL
HDL cholesterol: 32 mg/dL

Questions

1. Based on these blood results, what management is appropriate?
2. Should any physical exam be performed?