Chest pain presentations are common, but management can be variable and difficult to understand. Here is my approach:Read More
In general practice (and in secondary care), we discuss at length lifestyle modifications that aid blood pressure lowering. But exactly how effective are the various strategies?
There are 5 things we could do to reduce our blood pressure, without medications.Read More
Traditionally, we are taught that laboratory tests have “normal ranges”, such as in haemoglobin or creatinine. However, this concept of “normal”, when applied in cholesterol measurement, often creates confusion amongst some clinicians and certainly in most patients.Read More
In primary prevention, CT calcium scoring has been suggested to help decision making surrounding statin use.
Some of the underlying concepts are somewhat complex, but the screening paradigm remains that of matching the intensity of preventive efforts with the individual’s absolute risk.
The appropriateness of CT calcium scoring in an individual patient therefore depends
patient’s pretest probability of atherosclerotic cardiovascular risk
potential benefits of preventive therapies
negative aspects and risks of preventive therapies
A 40-year-old Maori man came for routine review concerned because his 38-year-old brother, who was a smoker, died suddenly of a heart attack. The patient was athletic, previously played professional rugby, without clinical risk factors.
- BMI 28
- LDL 4.9; TC/HDL ratio 4
His calculated cardiovascular risk on these parameters was low. A reasonable approach would include
1) reinforcing healthy living and reassessing in 5 years
2) reinforcing healthy lifestyle and starting a statin
3) reinforcing healthy lifestyle, getting a CTCA, starting a statin
4) all of the aboveRead More