CVRA (. )

Cardiovascular Risk Assessment: Patient Information: Name: Mrs. Eleanor Vance Age: 58 Gender: Female Contact: 07700 900345 Reason for Assessment: Patient presents for a comprehensive cardiovascular risk assessment following a recent family history of myocardial infarction in her elder sister. She expresses concerns regarding her own risk factors and wishes to understand preventative measures. Patient reports occasional mild palpitations, especially after consuming caffeinated beverages, and general fatigue. Medical History: * Hypertension (diagnosed 5 years ago, managed with medication) * Dyslipidaemia (diagnosed 3 years ago) * Type 2 Diabetes (diagnosed 2 years ago, managed with diet and medication) * No history of previous cardiovascular events (e.g., angina, MI, stroke) * Cholecystectomy 10 years ago Family History: * Mother: Hypertension, Type 2 Diabetes, deceased from stroke at 72 * Father: Hyperlipidaemia, deceased from myocardial infarction at 68 * Sister (62): Myocardial infarction 3 months ago, currently recovering * Brother (55): No known significant medical history Lifestyle Factors: * Smoking status: Non-smoker for 10 years (previously smoked 15 cigarettes/day for 20 years) * Alcohol consumption: 2-3 units per week (socially) * Diet: Reports a varied diet, but admits to frequent consumption of processed foods and sugary snacks. States difficulty adhering to a healthier diet due to work schedule. * Physical activity: Sedentary lifestyle, walks approximately 20 minutes once or twice a week. No regular structured exercise. * Stress levels: Reports moderate stress due to work demands and caring for elderly parents. Medications: * Lisinopril 10mg once daily * Atorvastatin 20mg once daily * Metformin 500mg twice daily * Multivitamin once daily Allergies: * Penicillin (rash) * Sulfa drugs (hives) Physical Examination: * Blood Pressure: 145/92 mmHg (sitting, right arm) * Heart Rate: 78 bpm, regular rhythm * BMI: 31.5 kg/m² (Height: 160 cm, Weight: 80.6 kg) * Waist Circumference: 98 cm * General: Mild central obesity, no peripheral oedema. Lungs clear to auscultation. Heart sounds normal, no murmurs. No carotid bruits. Laboratory Results (1 November 2024): * Total Cholesterol: 5.8 mmol/L * LDL-C: 3.5 mmol/L * HDL-C: 1.1 mmol/L * Triglycerides: 2.1 mmol/L * Fasting Glucose: 7.2 mmol/L * HbA1c: 7.1% * hs-CRP: 2.5 mg/L * eGFR: 75 mL/min/1.73m² Risk Assessment: Based on the collected information, Mrs. Vance is at high risk for cardiovascular disease. Her risk factors include age (58, female), positive family history, hypertension, dyslipidaemia, Type 2 Diabetes, elevated BMI, central obesity, sedentary lifestyle, and suboptimal dietary habits. While her hs-CRP is mildly elevated, it contributes to the overall risk picture. A SCORE2-OP (Systematic Coronary Risk Estimation 2-Older Persons) assessment, considering her age and comorbidities, places her in the high-risk category for a 5-year fatal and non-fatal cardiovascular event. Given the family history of early-onset MI, her genetic predisposition is also a significant factor. Recommendations: * **Lifestyle Modifications:** * **Diet:** Referral to a dietitian for structured guidance on a heart-healthy diet (e.g., Mediterranean-style diet), focusing on reducing processed foods, saturated fats, and sugars. Emphasis on increasing fruit, vegetable, and whole grain intake. * **Physical Activity:** Gradual increase in physical activity. Begin with 30 minutes of moderate-intensity activity (e.g., brisk walking) most days of the week, with a goal of 150 minutes/week. Referral to a community exercise programme. * **Weight Management:** Aim for a 5-10% reduction in current body weight over the next 6-12 months. * **Stress Management:** Explore stress reduction techniques such as mindfulness or yoga. * **Medications:** * Discuss with GP potential for optimisation of current antihypertensive and lipid-lowering therapy given current readings. * Consider initiation of low-dose aspirin, in consultation with GP, after a thorough risk-benefit analysis. * **Monitoring:** Regular home blood pressure monitoring. Patient Education: Comprehensive education provided regarding the importance of managing hypertension, dyslipidaemia, and diabetes. Discussed the link between lifestyle choices and cardiovascular health. Emphasised the significance of adherence to medication and regular follow-up. Information leaflets on heart-healthy eating and physical activity were provided. Patient expressed understanding of her risk factors and willingness to make lifestyle changes. Follow-Up Plan: * Review with GP in 2 weeks to discuss medication adjustments and aspirin initiation. * Appointment with dietitian scheduled for 3 weeks. * Follow-up acupuncture session in 1 month to address general well-being and stress reduction, which can indirectly support cardiovascular health. Focus areas will include liver qi stagnation and spleen qi deficiency patterns identified during initial assessment, aiming to harmonise the body's energy for improved metabolic function and emotional balance. * Repeat lipid profile and HbA1c in 3 months. Repeat blood pressure check with GP in 3 months.