Cardiovascular Medicine Q26

A 44-year-old man is evaluated in the office during a routine visit. Medical history is significant for HIV diagnosed at age 25 years, hypertension, and hyperlipidemia. He is a current smoker. Medications are chlorthalidone, tenofovir-emtricitabine, and raltegravir.

On physical examination, the patient is afebrile, and blood pressure is 126/74 mm Hg. Cardiac examination reveals a regular rate and rhythm. S1 and S2 are normal; there is an S4.

Laboratory tests are significant for a fasting plasma glucose level of 98 mg/dL (5.43 mmol/L), a total cholesterol level of 210 mg/dL (5.43 mmol/L), and an HDL cholesterol level of 50 mg/dL (1.29 mmol/L).

An electrocardiogram shows normal sinus rhythm and left ventricular hypertrophy with repolarization abnormalities. A chest radiograph is normal.

To determine his need for statin therapy, his estimated 10-year risk for atherosclerotic cardiovascular disease using the Pooled Cohort Equations will be calculated.

Which of the following risk factors will result in underestimation of the risk for atherosclerotic cardiovascular disease in this patient?

HIV status

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