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Lifestyle Issues in Cardiac Health

Followup Visits

Mr. Fowler returns to the physician after three months and again six months after the initial visit. On each occasion, he reports that he is not smoking cigarettes. He stopped the bupropion after taking it for 4 months. He feels optimistic that he will not resume smoking.

On each of these visits, he indicates that he is adhering to his diet and exercise program. By the six-month visit, he is walking two miles a day at a rate of 15 minutes per mile, five or six times per week. He is also playing tennis for about an hour on weekends.

At the three-month visit, his weight is 185 pounds, and his blood pressure is 140/84 mmHg. At the six-month visit, his weight is 182 pounds and his blood pressure is 142/82 mmHg. Blood pressure readings that he brings in from measurements at the mall show a systolic range of 132-146 mmHg and a diastolic range of 76-86 mmHg.

At the time of his six-month visit, his fasting serum glucose is 105 mg/dL and his fasting lipid profile consists of HDL-cholesterol of 36 mg/dL, LDL-cholesterol of 138 mg/dL, triglyceride of 150 mg/dL and total cholesterol of 204 mg/dL.

Questions

1. Should he be started on a lipid-lowering agent?
2. Should he be started on an anti-hypertensive agent?
3. Should he be advised to take aspirin on a daily basis?