Lifestyle Issues in Cardiac Health
Management After Lifestyle Changes
The physician informs Mr. Fowler that the fasting serum glucose indicates that he has glucose intolerance and therefore is at risk of developing overt type 2 diabetes mellitus and cardiovascular disease in the future. The physician indicates that this increases the importance of weight reduction through diet and exercise. The physician also informs Mr. Fowler that his lipid profile is suboptimal. The LDL is higher and HDL is lower than desirable. This pattern is associated with an increased risk of cardiovascular disease. The physician indicates that in the presence of other risk factors, such as cigarette smoking, stage 1 hypertension, mild obesity and a positive family history, this lipid profile is concerning.
She indicates that the first step is a low calorie, low cholesterol, low saturated fat diet. If this does not improve the lipid pattern, a lipid-lowering drug will be needed. The patient indicates that he understands this and wants to avoid medication, if possible. He reports that he and his wife are committed to a weight loss program that hopefully will improve his lipid status and avert the need for medication.
The physician also discusses the patient's use of alcohol. Mr. Fowler indicates that he has never had any problems with alcohol, that he never drives after drinking, that he has never had difficulty at home or at work because of his drinking, and that he has not been intoxicated for many years. He inquires as to whether his use of alcohol is a risk factor for cardiovascular disease. The physician informs him that his level of drinking does not constitute a risk factor and might even have a beneficial effect on his cardiovascular status. The physician, however, emphasizes the importance of moderation in the use of alcohol.
The physician also inquires as to whether Mr. Fowler wants to discuss his problems with libido and sexual function. He indicates that at this time he does not want to pursue this, but might be interested in the future. During this visit his blood pressure is 145/92 mmHg, pulse rate is 86 per minute and weight is 196 lb. No other exam is performed.
Questions
- When should he be seen in follow-up?
- Using the Framingham scoring system, what is his risk for cardiovascular disease over the next 10 years?