January 27th, 2014
Prevention Guidelines in Practice: Vignette 3
This vignette is the third in our series “Making Sense of the New Prevention Guidelines — The View from Clinical Practice”
A 41-year-old African-American woman presents to clinic. She has a total cholesterol of 165 mg/dL, HDL of 40 mg/dL, and SBP of 145 mm Hg. She is a smoker and is not taking medical treatment for hypertension. Her Pooled Cohort Equations estimated 10-year CVD risk is 4.2%.
A week later, she presents to the clinic again for a repeat blood-pressure check. Her SBP is now 166 mm Hg, which changes her estimated 10-year CVD risk to 8.4%.
- Would you start this patient on a statin?
- Would you measure her BP again or use the average of the two SBPs already obtained to calculate estimated 10-year CVD risk?
- Would you assess other risk markers, as recommended by the new AHA guideline for cardiovascular risk estimation, such as family history, hs-CRP, CAC scores, or ABI? If so, how would these results guide your recommendation for or against statin initiation?