Clinical Geriatrics

Case Vignette

An 87-year-old man with well-controlled hypertension and no known cardiovascular disease had his cholesterol checked at a local health fair. He comes to the physician’s office with the following results: total cholesterol 245 mg/dL, triglycerides 141 mg/dL, high-density lipoprotein cholesterol (HDL-C) 57 mg/dL, and low-density lipoprotein cholesterol (LDL-C) 160 mg/dL. He is very functional and active, with no symptoms of angina or heart failure. How should this patient be managed?

Introduction

The National Cholesterol Education Program (NCEP)

Author Affiliations:

From the Department of Medicine, Cardiology Division, New York Medical College/Westchester Medical Center, Valhalla, NY.

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Introduction

Hypertension in older persons is a major risk factor for coronary events,1-3 for stroke,1,4-6 for congestive heart failure (CHF),1,7,8 and for peripheral arterial disease.9-12 Older persons are more likely to have hypertension and isolated systolic hypertension, to have target organ damage and clinical cardiovascular disease, and to develop new cardiovascular events, and are less l

One of the major health concerns for older persons is their potential risk for serious cardiovascular events, a risk that rises dramatically with increasing age.1^1,2 For example, the average annual rate of first major cardiovascular events rises from 7 per 1000 men at ages 35-44 years to 68 per 1000 men at ages 85-94; comparable rates occur in women 10 years later in life.³

Coronary heart disease (CHD) is more prevalent in the elderly, with over 83% of cardiovascular disease deaths in the United States occurring in individuals age 65 years or older.⁴ Indiv

CASE PRESENTATION
A 62-year-old functional but cachectic male, who was able to ambulate with a walker, presented to the emergency department (ED) with a temperature of 102.3 degrees F, and neck and low back pain. The patient reported having had subjective fever and chills at home starting 1 week prior to the hospital visit. He also reported generalized fatigue, occasional shortness of breath, and a 20-pound weight loss over 2 weeks. There were no reported changes in mental status. The patient did have a recent history of having had a left carotid sinus takedown with removal of the optic nerve

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CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.0 category 1 credit toward the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit th