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Case #346: What’s in your family?
We’ve all seen the Capital One commercials with the familiar line, “what’s in your wallet? One of the most important questions in assessing cardiovascular risk is “what’s in your family?” For our patient, “Eric,” family history has a powerful impact on his current health concerns, informs CV risk assessment and influences treatment decisions.
Eric came to our office as a new patient in October 2008 at age 39. He was concerned about his family history and was asking for a complete physical. Eric’s family history included:
- His father suffered a stroke in 2007 at age 65
- His father also has high cholesterol, hypertension and diabetes with a Hx of alcohol and tobacco use/abuse
- A paternal grandfather who had a heart attack and died in his early 50s
- A maternal grandmother who had breast cancer
The patient reported mild, intermittent seasonal asthma. Otherwise, Eric exercises regularly, is a non-smoker and infrequent alcohol user. His complete physical showed:
- Height = 73.25 inches
- Weight = 184 lbs
- Waist < 35 inches
- BMI = 24.1
- BP = 120/80
- RR = 16
- HR = 68
- Hepatitis B/C panel = all negative; surface antibody (Anti-HBs) positive due to immunization
The patient’s SLP (recently performed) showed:
- TC = 210
- TG = 142
- HDLc = 46
- LDLc = 136
- VLDLc = 28 (estimated from SLP)
Eric’s CMP was normal; AST and ALT were elevated at 85 and 59, respectively. He has no CAD risk factors according to NCEP due to his family CV events being too old to qualify. FRS was also not recommended due to lack of risk factors. He returned for his repeat labs in December 2008, this time with the VAP Test.
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