010-111 · Question #96
Mr. Smith wishes to enroll in your exercise program. Preliminary evaluation revealed the following information: Age = 50 years Resting heart rate = 78 beats/min Weight = 198 lb (90 kg) Resting blood p
The correct answer is D. Hypertension, high total cholesterol, smoking.. Mr. Smith's three clear ACSM positive CAD risk factors are hypertension (BP 162/94 mm Hg), high total cholesterol (240 mg/dl with low HDL), and current cigarette smoking.
Question
Mr. Smith wishes to enroll in your exercise program. Preliminary evaluation revealed the following information:
Age = 50 years Resting heart rate = 78 beats/min Weight = 198 lb (90 kg) Resting blood pressure = 162/94 mm Hg Height = 70 inches (178 cm) Body fat = 30% Blood chemistry:
Total cholesterol = 240 mg/dl (6.21 mmol/L) HDL cholesterol = 34 mg/dl (0.88 mmol/L) Triglycerides = 180 mg/dl (2.03 mmol/L) Glucose = 98 mg/dl (5.55 mmol/L) Family history and current habits:
Father died of heart attack at 90 years of age Hypertensive mother died at age 84 Smokes a pipe after dinner each evening Smokes cigarettes (25-30 per day) Reports too much work and is struggling to meet deadlines Currently doing moderate exercise No medications at present According to ACSM stratification guidelines, Mr. Smith has which of the following coronary artery disease risk factors?
Options
- AHypertension, obesity, high total cholesterol:HDL ratio.
- BSmoking, probable diabetes, high blood pressure.
- CSmoking, high total cholesterol, aggressive type A personality.
- DHypertension, high total cholesterol, smoking.
How the community answered
(31 responses)- A3% (1)
- B10% (3)
- C6% (2)
- D81% (25)
Why each option
Mr. Smith's three clear ACSM positive CAD risk factors are hypertension (BP 162/94 mm Hg), high total cholesterol (240 mg/dl with low HDL), and current cigarette smoking.
This choice omits cigarette smoking - one of the strongest identifiable risk factors - and substitutes obesity, which is borderline given his calculated BMI of approximately 28.4, which falls below the ACSM obesity threshold of >=30.
His fasting glucose of 98 mg/dl falls below the ACSM impaired fasting glucose threshold of >=100 mg/dl, so probable diabetes is not a positive risk factor for Mr. Smith.
Type A personality is not an ACSM-recognized positive CAD risk factor in formal stratification criteria, making this choice technically invalid regardless of the other items listed.
Mr. Smith's resting blood pressure of 162/94 mm Hg exceeds the ACSM hypertension threshold of >=140/90 mm Hg, qualifying as a positive risk factor. His total cholesterol of 240 mg/dl exceeds 200 mg/dl and his HDL of 34 mg/dl falls below the 40 mg/dl male threshold, both confirming dyslipidemia as a positive risk factor. His daily cigarette habit of 25-30 cigarettes is an unambiguous positive risk factor; his father's death at age 90 and mother's at age 84 do not meet the premature family history threshold and are therefore negative risk factors.
Concept tested: ACSM CAD positive risk factor identification and stratification
Source: https://www.acsm.org/education-resources/books/acsms-guidelines-for-exercise-testing-and-prescription
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