A 68 year old diabetic male presents to a clinic for advice on prevention of a further heart attack after having sustained a myocardial infarction four years previously. He takes Metformin 500 mg tds, bendrofluazide 2.5 mg daily and Asprin 150 mg daily. BMI was 34.5 kg/m2, with a pulse of 85 beats per minute regular and a blood pressure of 150/90 mmHg. His cholesterol level is 3.4 mmol/l (< 5.5). What is the most appropriate strategy for this patient?
ANSWER (5) Ramipril
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- 24 hr Holter Monitoring
- Atorvastatin
- Increase the dose of Aspirin from 150 mg to 300 mg daily
- Orlistat
- Ramipril
ANSWER (5) Ramipril
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Understood that you want to add an ACE-Inhibitor. But if a real-life patient with a BMI =34.5 came to me and asked, "How do I prevent a further heart attack" - I'd say: #1) Lose weight. #2) Lose weight. #3) Lose weight = Life-style change being far more effective (and less expensive) than any set of pills could ever be. Also - Didn't know which "cholesterol" you were referring to - and for those of us in the US, would be wonderful to provide conversions into mg/dL- THANK YOU from Florida in the US! - : )
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