ACP InternistMKSAP Quiz: Risk Assessment in a Healthy Patient

Test yourself on a patient’s cardiovascular disease assessment.

A 45-year-old asymptomatic male presents for a routine visit. He has an unremarkable medical and family history, does not smoke, exercises moderately, and follows a Mediterranean diet. His blood pressure is 120/78 mm Hg, BMI is 25, and other vitals are normal. The question at hand is the most appropriate approach for assessing his cardiovascular disease risk.

Cardiovascular disease is the leading cause of morbidity and mortality in the United States, accounting for 1 of every 3 deaths among adults.

Question:

Which of the following is the most appropriate cardiovascular disease assessment for this patient?

• Calculating cardiovascular disease risk: The US Preventive Services Task Force (USPSTF) recommends using the Pooled Cohort Equations to calculate the 10-year risk for atherosclerotic cardiovascular disease (ASCVD) in adults aged 40 to 75 years. This approach has shifted from routine serum lipid level measurement to identifying adults with a 10-year risk for a cardiovascular event that is 10% or greater.
• Carotid artery ultrasonography: The USPSTF does not recommend this screening in the general adult population due to the low prevalence of carotid stenosis (0.5%-1%) and the high rate of false-positive results.
• ECG: The USPSTF does not recommend screening for coronary artery disease with either resting or exercise ECG in asymptomatic patients at low risk, defined as a 10-year cardiovascular event risk less than 10%.
• Exercise stress test: Similar to ECG, this is not recommended for asymptomatic patients at low risk for cardiovascular events.
• No cardiovascular disease assessment: Although cardiovascular disease is a leading cause of morbidity and mortality, the rationale for calculating cardiovascular risk is to identify candidates for preventive interventions among asymptomatic individuals between 40 and 75 years of age.

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