Abstract
Case Presentation: Mr A is a healthy 38-year-old black male who comes to the clinic as a self-referral after a blood pressure check during “Health Day” at his job. Mr A is concerned because “high blood pressure” runs in his family. He reveals that his 58-year-old mother recently suffered a mild stroke and also takes water pills to reduce swelling in her legs. He denies any other health problems, is a non-smoker, and takes no medications. On physical examination, his supine blood pressure is 165/85, his heart rate is 74 bpm, and his weight is 72 kg. An ECG shows normal sinus rhythm at 76 bpm and evidence of left ventricular hypertrophy. A fasting lipid profile shows a total cholesterol level of 196 mg/dL, a low-density lipoprotein cholesterol (LDL-C) level of 120 mg/dL, a high-density lipoprotein cholesterol (HDL-C) level of 50 mg/dL, a triglyceride level of 130 mg/dL, and C-reactive protein level of 3.5 mg/L. What clinical strategy would be most appropriate for Mr A? What is the available scientific evidence to support your choice(s)? Despite advances in the diagnosis and treatment of cardiovascular disease (CVD), morbidity and mortality from CVD is higher among black Americans than among white, Hispanic, and Asian Americans.1 Although black Americans are often considered to have less obstructive coronary heart disease than age-matched whites,2,3 the prevalence of traditional risk factors for CVD such as hypertension, diabetes mellitus, smoking, and obesity disproportionately affects black Americans. However, the relative importance of these risk factors and others, such as left ventricular hypertrophy, dyslipidemia, and novel risk determinants such as C-reactive protein and lipoprotein (a), on morbidity and mortality is unclear. At the population level, research efforts have focused primarily on the components of the Framingham Cardiovascular Risk Equation that were developed in a predominantly white cohort. …
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