010-111 · Question #157
Your client is a 59 year old sedentary female with a body mass index of 33 kg/m2. She has no history of heart disease herself, but her mother had a myocardial infarction at the age of 66. She is an…
The correct answer is B. Three. Applying ACSM CAD risk factor thresholds to this client's profile yields exactly three positive risk factors: obesity, sedentary lifestyle, and dyslipidemia (low HDL).
Question
Your client is a 59 year old sedentary female with a body mass index of 33 kg/m2. She has no history of heart disease herself, but her mother had a myocardial infarction at the age of 66. She is an ex-smoker who quit 15 years ago, blood pressure is consistently 135/85 mm Hg, total cholesterol is 180 mg/dL (4.6 mmol/L) with an HDL level of 30 mg/dL (0.8 mmol/L), and blood glucose is 100 mg/dL (5.6 mmol/L). She has come to you for advice because she wishes to improve her overall health and fitness. How many risk factor thresholds for coronary artery disease does this client possess?
Options
- ATwo
- BThree
- CFour
- DFive
How the community answered
(28 responses)- A14% (4)
- B75% (21)
- C7% (2)
- D4% (1)
Why each option
Applying ACSM CAD risk factor thresholds to this client's profile yields exactly three positive risk factors: obesity, sedentary lifestyle, and dyslipidemia (low HDL).
Two factors is insufficient; three distinct ACSM criteria - obesity, sedentary lifestyle, and low HDL - each independently meet their respective positive risk factor thresholds.
The three positive ACSM CAD risk factors are obesity (BMI 33 kg/m2 meets the ≥30 threshold), physical inactivity (sedentary lifestyle with no structured exercise program), and dyslipidemia (HDL of 30 mg/dL is below the <40 mg/dL threshold). Family history is negative because the mother's MI at age 66 does not satisfy the <65-year threshold for female first-degree relatives, smoking is negative because cessation occurred 15 years ago rather than within the required 6-month window, and BP of 135/85 mmHg falls below the ≥140/90 mmHg hypertension threshold.
Four would require an additional factor such as hypertension (BP 135/85 does not meet ≥140/90) or confirmed impaired fasting glucose (a single reading of 100 mg/dL is not confirmed on two occasions), neither of which clearly qualifies.
Five factors would require counting family history, cigarette smoking, and hypertension in addition to the confirmed three, but none of those three meet their respective ACSM threshold criteria for this client.
Concept tested: Counting ACSM positive CAD risk factors from clinical data
Source: https://www.acsm.org/education-resources/books/guidelines-exercise-testing-prescription
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