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Lifestyle Issues in Cardiac Health

Lifestyle Issues

After the physical examination, the physician addresses the following issues with Mr. Fowler: his weight; his sedentary lifestyle; his cigarette smoking; and his blood pressure. The physician informs the patient that the body mass index of 28.6 indicates that he is overweight and that this increases his risk of cardiovascular disease, diabetes mellitus and certain other medical problems. The physician explores the patient's interests in losing weight. Mr. Fowler indicates that he realizes he is overweight and that he needs to lose weight. He expresses an interest in pursuing a weight control program. The physician arranges for the patient and his wife to meet with a dietitian in the next week.

The physician inquires as to the patient's interest in developing a program of regular exercise. Mr. Fowler expresses interest in this, but has no interest in swimming, bicycling or jogging. He does indicate that it might be feasible for him to develop a program that consists of walking on a regular basis. The physician encourages him to seriously consider this, but advises him to start very slowly and attempt only short distances initially and to gradually increase his speed and distance.

Mr. Fowler reports that he is somewhat discouraged about the likelihood of smoking cessation given his two unsuccessful attempts in the past. The physician reinforces the importance of smoking cessation and encourages him to consider another attempt. The physician informs him that most people who successfully stop smoking do so only after several failed attempts. She encourages Mr. Fowler to build on his experiences with smoking cessation in the past and to learn from his failures. The physician discusses various strategies, including the use of either bupropion and/or nicotine replacement therapy and emphasizes the importance of a comprehensive smoking cessation program that involves counseling. Mr. Fowler indicates that he will think about this.

The physician also expresses concern about the blood pressure. She advises Mr. Fowler to have his blood pressure checked once or twice a week over the next one to two months and to keep a record of the measurements. She also advises him to significantly reduce his intake of salt and gives him some written information about the salt content of various food items. She also indicates that his blood pressure might decrease with weight loss. The physician emphasizes the seriousness of high blood pressure as a cardiovascular risk factor and indicates that the patient might need to take medication to control his blood pressure if the blood pressure remains elevated.

The physician recommends that Mr. Fowler have blood collected after a 10-12 hour fast for measurement of serum glucose to screen for type 2 diabetes mellitus and assessment of his lipid profile to screen for hyperlipidemia. The patient agrees with this recommendation and returns the following morning for collection of the fasting specimen.

Questions

1. Should a resting EKG be obtained to screen for heart disease?
2. Should an exercise EKG be performed to screen for heart disease?
3. Should a chest x-ray be obtained to screen for lung cancer and chronic obstructive pulmonary disease?
4. Does his reported use of alcohol increase the risk of atherosclerotic cardiovascular disease?
5. Is any other blood test indicated at this time?