Determining Your Patient's Cardiac Risk

A45-year-old nonsmoking woman with diabetes comes to your office for a new patient visit. Her medical history is notable for diabetes that has been diagnosed for 5 years, two normal vaginal deliveries, and a tubal ligation. For exercise, she walks for 30 minutes three times per week. Her medications include glipizide, 10 mg per day, and loratadine for allergic rhinitis. Physical exam reveals a blood pressure of 130/80 mmHg and a BMI of 27 kg/m² and is otherwise normal. A recent workplace health screening exam revealed a total cholesterol level of 230 mg/dl, an HDL cholesterol level of 60 mg/dl, an LDL cholesterol level of 130 mg/dl, and triglycerides of 200 mg/dl. Her hemoglobin A_1c (A1C) is 7.2%. In the course of your visit, she asks you if she is at risk for heart disease and if she needs to do anything to lower her risk.

Later that day, you see another new patient, a 50-year-old nonsmoking man. He has had diabetes for 15 years and has treated hypertension. He is physically inactive. His medications include glipizide, 10 mg per day, and metformin, 1,000 mg twice daily. His blood pressure is 140/70 mmHg, and his BMI is 32 kg/m². The physical exam is otherwise unremarkable. A recent workplace health screening exam revealed a total cholesterol level of 170 mg/dl, an HDL cholesterol level of 30 mg/dl, an LDL cholesterol level of 90 mg/dl, and triglycerides of 200 mg/dl. His …