Description

ORIGINAL QUESTION:

Steve, a 54-year-old Caucasian male, presents for a first-time visit to your clinic. His history includes five sexual partners in the last 25 years, two of those within the last twelve months, lack of physical activity of any kind as he is an over-the-road truck driver, 25-year history of smoking 1 pack per day, and no immunizations of any kind that he can recall since high school.  His father died of a myocardial infarction at age 62.  His mother is alive and has hypertension, hyperlipidemia, and Type 2 Diabetes.

His BMI is 31 and his blood pressure is 142/90.

Name one disease he is at risk for and provide evidence on how one of his risk factors is tied to the causation of that disease. 

ANSWER:

According to the patient family history, this person is at risk of developing cardiovascular heart disease and diabetes because some of these conditions can be genetically acquired. The patient lifestyle can influence his health and the risk of acquiring the disease. In the case study, we have seen that the patient father died of myocardial infarction, and as far as medicine is concerned, high blood pressure runs in the family and this person is at risk of developing the disease. The patient sexual behavior can lead to causing high blood pressure in men at some point in their life. The patient's race can also predispose him to develop high blood pressure in their earlier life. 

The patient’s blood pressure (systolic and diastolic), are not within the normal range of 120/80mmhg and is elevated according to his age. The patient is not doing any physical activities in the last 12 months because of the nature of his work. Most of the time he spends on the road driving and this can contribute to obesity. This is seen in his BMI 31 which indicates that this person is obese and needs to do exercise in order to lose weight. The normal BMI should be 18.5 to 24.9; this person is at a high risk of getting bad cholesterol levels in his blood. Smoking of cigarettes can increase his blood pressure and heart rate, which can lead to building up of fatty substance inside the arteries. The blood pressure rises because of increased cardiac output and the total peripheral vascular resistance. The blood pressure may take time to rise or may rise immediately and these happen before any increase in the circulation of catecholamine. In hypertensive patients, the blood pressure-lowering the effect of beta-blockers may be partly removed as a result of smoking tobacco whereas alpha-receptor blockers seem to hold the antihypertensive efficacy in people who smoke

References

Mahmood, S. S., Levy, D., Vasan, R. S., & Wang, T. J. (2014). The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective. The Lancet, 383(9921), 999-1008.

QUESTION TO ANSWER:

Thank you for your discussion of Steve and his risk factors. As you look at this, what would you consider is the most important modifiable risk factor that you would tackle first? How would you help Steve prioritize?