A 75-year-old man with 10-pack-year smoking history, hypertension, and mild chronic obstructive pulmonary disease presents to your office concerned because several of his friends have recently passed away from “heart attacks.” He states that he quit smoking approximately 7 years ago.

His physical exam is within normal limits. He has no history of prior cardiac events. He walks 30 minutes daily at a brisk pace without symptoms. His blood pressure is 138/79 mm Hg, and his most recent lipid panel shows a total cholesterol of 200 mg/dL with a low-density lipoprotein level of 155 mg/dL and high-density lipoprotein level of 45 mg/dL. His current medications include hydrochlorothiazide 25 mg daily and albuterol as needed for mild chronic obstructive pulmonary disease.

He wants to know how to reduce his future risk of having a myocardial infarction.

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