Atypical chest pain
Henry is a 55-year-old man who developed atypical chest pain. He had a positive stress exercise test and a coronary angiogram that revealed two vessel non-obstructive coronary disease. His risk factors include treated hypertension and an LDL-C of 130 mg/dL. His HDL-C is 39 and fasting TG is 145 mg/dl. He is a non-smoker, and his most recent fasting blood glucoses have been 107 and 113 mg/dL. The A1c was 6.8%.
Family History: His father had an MI at age 67. His mother had T2DM at age 60.
Social History: He is a retired veteran, and eats out one to two meals per day. He has limited intake of whole grains and three to four servings of fruits and vegetables daily, no fish. No daily exercise. Reformed smoker. He quit 10 years ago, 20 pack/year history. No alcohol. Henry is married and lives with his wife and mother.
Medications: He is on a low dose aspirin 81 mg daily, long-acting beta blocker (metoprolol 50 mg daily), a high-intensity statin (atorvastatin 40 mg daily) and an ACE inhibitor (enalapril 10 mg daily).
Exam: BP 135/86, P 58, 183 lbs. and BMI 26.3 kg/m2, WC 99 cm
Exam otherwise NR.