Case 1: a 62-year-old woman comes to you as a new patient. She has no complaints but needs preventive care. She smokes one pack of cigarettes per day and is on no medications. She does no regular physical exercise and has a desk job. She has no chronic medical problems. Her blood pressure is 150/90 mmHg, and she has a body mass index (BMI) of 38 kg/m2 and a waist-to-hip ratio of 1.2. There are no other physical exam abnormalities. You order fasting screening labs, which show total cholesterol of 265 mg/dl (6.9 mmol/l), low-density lipoprotein (LDL) 180 mg/dl (4.7 mmol/l), high-density lipoprotein (HDL) 25mg/dl (0.65mmol/l), triglycerides 300mg/dl (3.4mmol/l), and glucose 180 mg/dl.
Case 2: a 65-year-old woman presents for new patient evaluation after a recent hospitalization for an inferior myocardial infarction (MI). She was treated acutely with angioplasty and stent placement in the right coronary artery. She also has a 30% left anterior descending coronary artery lesion and a 20% circumflex lesion. Her ejection fraction is 40%. She has had no further angina and denies symptoms of congestive heart failure. She smokes half a pack of cigarettes per day and proudly tells you this is much less than she used to smoke. She has no other chronic medical problems.
She is taking atenolol, aspirin, and atorvastatin. Her blood pressure is 160/100mmHg, pulse is 90bpm, BMI is 35kg/m2, and the reminder of her examination is unremarkable. In hospital, her cholesterol was 330 mg/dl (8.5mmol/l), LDL190mg/dl (4.9mmol/l), HDL40 mg/dl (1.0mmol/l), triglycerides 500 mg/dl (5.6 mmol/l), and hemoglobin A1C 6.0%.
What can be offered in each of these cases to reduce the patients' coronary heart disease (CHD) risk/risk of CHD reoccurrence?
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