Management of Cardiovascular Risk Factors in a Middle-Aged Housewife
Anna, a 40-year-old housewife with a family history of cancer and diabetes, presents with elevated blood glucose levels, high cholesterol, and hypertension. Initial management includes lifestyle changes, medication for blood pressure and cholesterol, and smoking cessation. Follow-up visits show improvement in weight, blood glucose, and cholesterol levels but with room for further optimization. Adjustments in treatment and monitoring are needed to achieve better control of cardiovascular risk factors.
- Cardiovascular health
- Lifestyle modification
- Medication management
- Health monitoring
- Risk factor control
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Presentation Transcript
Anna, 40 year, housewife Family history Father dead @ 56 yr for larinx cancer Mother w/diabetes, dead @ 85 yr for stroke 10 bro/sis: 5 brothers (4 healthy, 1 dead for larinx cancer), 5 sisters (4 healthy, 1 w/ diabetes)
Anna, 40 year, housewife Personal history 6 pregnancies, 1 abortion 5 kids, the first @ 15 yr, the last @ 23 yr @ 20 yr, BP normal during the summer, a little hihj during the winter. GP did not prescribe any therapy, heavy smokers since @ 15 yr (40/day) @ 30 yr: Chol 215, TG 80, HDL 65 (LDL 134, non-HDL 150)
Anna, 40 yr, housewife (75 kg, 167 cm, BMI 27) Personal history Since she did not feel well and observed a light body weight loss (2.5 kg): FPG: 170 mg/dl HbA1c: 8.3% Chol: 230; TG: 92; HDL: 63 (LDL: 149; NON-HDL: 167). BP 150/90 mmHg, Fc 75 bpm Anything else normal
What to do? 1. Should Anna do any further evaluation to clarify the clinical picture? 2. Which are the targets of the treatment? 3. Which therapy?
Anna, 40 yr, housewife (75 kg, 167 cm, BMI 27) First visit prescription Stop smoking Low calorie diet (1400 kcal/die, 55% CHO, 30% Fat, 15% proteins, NO sugars, fibers, etc) Lifestyle Ramipril 5 mg tb, 1 tb/die Rosuvastatin 20 mg tb, 1 tb/die Metformin 1000 mg tb, 2 tb/die New visit after 4 months
Anna Second visit, 4 mo after the first Anna followed the diet and the lifestyle suggestions. Reduced the number of sigarettes smoked (10-15/day) Weight 72 kg (167 cm, BMI 26) FPG: 134 mg/dl HbA1c: 7.0% Chol: 153 mg/dl; TG: 83 mg/dl; HDL: 56 mg/dl (LDL: 81; NON-HDL: 97). BP 132/84 mmHg, Fc 72 bpm Everything else normal
Anna I Visit II Visit III visita IV Visita Weight (Kg) 75 72 68,5 67 BMI (Kg/m2) 27 26 24,5 24 FPG (mg/dl) 170 134 110 104 Choleterol (mg/dl) 230 153 140 142 HDL (mg/dl) 63 56 52 52 LDL (mg/dl) 149 81 71 73 SBP/DBP (mmHg) 150/90 132/84 130/82 134/82 HbA1c (%) 8,3 7.0 6,50 6,40
What to do next? 1. Can we be satisfied? 2. Should we establish new target? 3. How would you change the treatment?
Anna Second visit, 4 months after the first visit Prescription More appropriate counseling to quit smoking Counseling again with the dietitian New Counseling for lifestyle. Introduction of daily step counting Addition of new antihyperglycemic treatment: Dulaglutide 0.75 mg s.c. weekly New visit in 4 months
Anna Third visit, 8 months after the first Anna followed the diet and the lifestyle suggestions. She further reduced the sigaretts (5/day) Weight 67 kg (167 cm, BMI 24) FPG: 101 mg/dl HbA1c: 6.1% Col: 140 mg/dl; TG: 86 mg/dl; HDL: 52 mg/dl (LDL: 71; NON-HDL: 88). PA 130/82 mmHg, Fc 74 bpm Everything else normal
Anna Dati I Visita II Visita III visita IV Visita Peso (Kg) 75 72 67 67 BMI (Kg/m2) 27 26 24 24 Glicemia (mg/dl) 170 134 101 104 Coleterolo tot. (mg/dl) 230 153 140 142 HDL (mg/dl) 63 56 52 52 LDL (mg/dl) 149 81 71 73 PAS/PAD (mmHg) 150/90 132/84 130/82 134/82 HbA1c (%) 8.3 7.0 6.10 6,40
What to do next? 1. Can we be satisfied? 2. Should we establish new target? 3. How would you change the treatment? 4. When next visit?
Anna Third visit, 8 months after the first visit More appropriate counseling to quit smoking Counseling again with the dietitian. Diet to 1800 kcal/die New Counseling for lifestyle. Increase: Dulaglutide 1.5 mg s.c. weekly New visit after 6 months
Anna Fourth visitt, 14 months after the first visit Anna followed the diet and lifestyle suggestion. She quit smoking Weight 65 kg (167 cm, BMI 23.3) Glicemia: 90 mg/dl HbA1c: 5.8% Col: 142 mg/dl; TG: 84 mg/dl; HDL: 52 mg/dl (LDL: 73; NON-HDL: 90). PA 134/82 mmHg, Fc 72 bpm Everything else normal
Anna Dati I Visita II Visita III visita IV Visita Peso (Kg) 75 72 67 65 BMI (Kg/m2) 27 26 24 23.3 Glicemia (mg/dl) 170 134 101 90 Coleterolo tot. (mg/dl) 230 153 140 142 HDL (mg/dl) 63 56 52 52 LDL (mg/dl) 149 81 71 73 PAS/PAD (mmHg) 150/90 132/84 130/82 134/82 HbA1c (%) 8,3 7.0 6.1 5.8
