Question of the Week

For May 12, 2020

A 28-year-old man with no significant medical history presents to discuss his cholesterol levels. He is married, has no children, does not use tobacco, drinks approximately seven alcoholic beverages per week, and denies the use of illicit drugs. He takes leisurely walks with his wife on weekends but is otherwise sedentary. Both of his parents have type 2 diabetes.

On physical examination, his height is 178 cm, his weight is 77 kg, and his BMI is 24.4. His seated blood pressure is 125/80 mm Hg, and his heart rate is 76 beats per minute. His waist circumference is 88 cm. The remainder of his examination is unremarkable.

His fasting laboratory testing yields the following results:

Patient value

Glucose (mg/dL)

90

Glycated hemoglobin (%)

5.5

Total cholesterol (mg/dL)

187

LDL cholesterol (mg/dL)

130

HDL cholesterol (mg/dL)

31

Triglycerides (mg/dL)

130

His lifetime risk of atherosclerotic cardiovascular disease is estimated at 36%.

Which one of the following recommendations is most appropriate for this patient?

Recommend reduced alcohol intake
Recommend an aerobic exercise program
Initiate niacin
Initiate fenofibrate
Initiate atorvastatin

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