Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 49-year-old man is evaluated during a routine examination. He is asymptomatic but is concerned about his risk for cardiovascular disease. Medical history is notable for hypertension. He is a nonsmoker, and he works as an executive at a highly successful company. Family history is noncontributory. His only medication is hydrochlorothiazide.
On physical examination, the patient is afebrile, blood pressure is 118/78 mm Hg, and pulse rate is 78/min. BMI is 31. The remainder of the physical examination is normal.
Results of laboratory studies show a serum total cholesterol level of 190 mg/dL (4.92 mmol/L) and a serum HDL cholesterol level of 46 mg/dL (1.19 mmol/L). Fasting plasma glucose level is 95 mg/dL (5.27 mmol/L).
His estimated 10-year risk of atherosclerotic cardiovascular disease using the Pooled Cohort Equations is 3.2%.
In addition to diet and exercise, which of the following is the most appropriate next step in management?
A: Coronary artery calcium scoring
B: Exercise electrocardiography
C: Resting electrocardiography
D: No further testing
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