question

[daisy78]

47 y/o chinese american man comes for f/u and has pmh of htn, dm, high lipids. tob abuse x 20 y,, meds are asa, ramipril, metformin, pravastatin. exam is nl with temp 98, bp 140/82, hr 74, rr 14. LDL is 140. which is most effective to decrease risk for acute coronary artery dz?

stop smoking
decrease cholesterol
htn control
weight control

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[Doc Ivy]

47 y/o chinese american man comes for f/u and has pmh of htn, dm, high lipids. tob abuse x 20 y,, meds are asa, ramipril, metformin, pravastatin. exam is nl with temp 98, bp 140/82, hr 74, rr 14. LDL is 140. which is most effective to decrease risk for acute coronary artery dz?

stop smoking
decrease cholesterol
htn control
weight control

Smoking-- most immediate and high impact on CAD risk, no?

 

[Shah_Patel_PT]

47 y/o chinese american man comes for f/u and has pmh of htn, dm, high lipids. tob abuse x 20 y,, meds are asa, ramipril, metformin, pravastatin. exam is nl with temp 98, bp 140/82, hr 74, rr 14. LDL is 140. which is most effective to decrease risk for acute coronary artery dz?

stop smoking
decrease cholesterol
htn control
weight control

Decrease cholestrol.....?

 

[footcramp]

smoking!

 

[mjl1717]

Decrease cholestrol.....?[/QUOTE

stop smoking!! If hes on pravastatin why say cholesterol??

 

[daisy78]

USMLEWORLD says lower his cholesterol, but I thought stop smoking.

 

[footcramp]

USMLEWORLD says lower his cholesterol, but I thought stop smoking.

what was the explanation? brochert says smoking cessation is more important than cholesterol control.

 

[betz]

LDL is 140. He has DM which is a coronary eq. So his goal would be under 100. But all of the choices are risk factors, and whats more important. Since it asks for acute coronary, I think I would have put smoking. Thats what frustrates me about USMLEworld. It has alot of similar answers. I found that the sample NBME has more straightforward vignettes and the answer choices arent as similar. Anyone taken the real deal have any thoughts on this? I guess I will see next week......

 

[Idiopathic]

Does anyone have the paper in front of them where it says reduction of cholesterol as an isolated risk factor shows a reduction in coronary artery disease? I havent seen it (doesnt mean it isnt out there). I have seen that overall it reduces morbidity and mortality but that many of these patients had low to normal cholesterol levels.

Smoking cessation is by far the most therapeutic (and cost effective) way to reduce CAD risk. Prevent the endothelial injury.

 

[VincentAdultman]

47 y/o chinese american man comes for f/u and has pmh of htn, dm, high lipids. tob abuse x 20 y,, meds are asa, ramipril, metformin, pravastatin. exam is nl with temp 98, bp 140/82, hr 74, rr 14. LDL is 140. which is most effective to decrease risk for acute coronary artery dz?

stop smoking
decrease cholesterol
htn control
weight control

BS question. And people say UW is a good source? Hell I'd have the knife to my wrist after 100 q's like that.

 

[46&2]

From Zipes: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed., Copyright © 2005 (ripped this off MD Consult):

"Cessation of cigarette consumption constitutes the single most important intervention in preventive cardiology. In a recent major overview, smoking cessation reduced coronary heart disease mortality by 36 percent as compared with mortality in subjects who continued smoking, an effect that did not vary by age, gender, or country of origin...

These 35 to 40 percent risk reductions are at least as great as other secondary prevention interventions that have received far more attention from physicians, including the use of aspirin, statins, beta-blockade, and angiotensin-converting enzyme inhibitors. "