General Internal Medicine Question 46

A 49-year-old man is evaluated during a routine examination. He is asymptomatic but is concerned about his risk for cardiovascular disease. Medical history is notable for hypertension. He is a nonsmoker, and he works as an executive at a highly successful company. Family history is noncontributory. His only medication is hydrochlorothiazide.

On physical examination, the patient is afebrile, blood pressure is 118/78 mm Hg, and pulse rate is 78/min. BMI is 31. The remainder of the physical examination is normal.

Results of laboratory studies show a serum total cholesterol level of 190 mg/dL (4.92 mmol/L) and a serum HDL cholesterol level of 46 mg/dL (1.19 mmol/L). Fasting plasma glucose level is 95 mg/dL (5.27 mmol/L).

His estimated 10-year risk of atherosclerotic cardiovascular disease using the Pooled Cohort Equations is 3.2%.

In addition to diet and exercise, which of the following is the most appropriate next step in management?

A  Coronary artery calcium scoring

B  Exercise electrocardiography

C  Resting electrocardiography

D  No further testing

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