Cardiovascular Risk And Prevention Practice Test

A 27-year-old man with obesity (BMI 33 kg/m²) and smoking presents for BP recheck. He smokes 15 cigarettes/day and reports high stress and minimal exercise. BP is 150/94 mm Hg. Labs: LDL 118 mg/dL, HDL 37 mg/dL, triglycerides 200 mg/dL, fasting glucose 102 mg/dL. He is not on medications. Family history is negative for early CAD. He asks whether vaping or “cutting down” is enough.

What preventive measure should be prioritized for this patient?

A 58-year-old postmenopausal woman with type 2 diabetes mellitus presents for routine care. She takes metformin 1000 mg twice daily and reports excellent adherence; home glucose logs are generally 90–130 mg/dL. She is sedentary due to an office job and knee discomfort, and she eats most meals from takeout. She does not smoke and drinks wine socially. BP is 136/82 mm Hg; BMI 29 kg/m². Recent labs: A1c 6.6%, total cholesterol 212 mg/dL, LDL 128 mg/dL, HDL 44 mg/dL, triglycerides 180 mg/dL, creatinine 0.9 mg/dL, urine albumin/creatinine ratio 18 mg/g. She is not taking a statin because she “feels fine.” Family history includes her mother having a fatal MI at age 54 and a maternal uncle with coronary bypass surgery in his 50s. She asks which medication change best lowers her risk of heart attack and stroke.

Which medication adjustment is most indicated based on the patient's profile?