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I have seen all your reports in detail (attachment removed to protect patient identity). Firstly, I would say that you are a non-smoker and a normotensive person. You are in late 30s. Your TMT and echo were normal and all the cardiac enzymes are normal. Your only sole risk factor is borderline elevated cholesterol and triglyceride level. Your lipid profile is not grossly deranged. For lowering your triglycerides and cholesterol, I would like to suggest you the following. Please consult your specialist doctor, discuss with him or her and take the medicines with consent. Take Tablet Atorlip F (Atorvastatin and Fenofibrate) 10/160 mg daily at bedtime for three months. You would have to repeat a lipid profile after three months. Do strenuous exercise for at least six days a week for 45 minutes per day. Take three types of oils and alter them every month. In general, 50 to 70 mL alcohol twice a week is cardioprotective and offers protection against any blockage. For your query regarding blockage, I would like to tell you that fatty streak (blocks) formation starts at the age of 10 years in human beings. So, every human more than 10 years of age have some amount of blockage in his coronary arteries (heart supplying artery), but only a blockage of more than 75% is significant and needs to be treated. Echocardiogram and TMT (treadmill test) have a sensitivity rate of about 70% individually and in combination this sensitivity also increases. As of now, you are totally asymptomatic. You are a non-smoker and occasional alcoholic with all blood reports normal. A premature stroke or CAD (coronary artery disease - heart disease) is very unlikely in early or late 30s unless a very strong family history is there or the person is a chronic smoker. My suggestion is to follow the medicine I suggested you for three months and thereafter repeat your lipid profile. But, if you want to be fully sure that you do not have a coronary artery blockage or stroke risk, then I would suggest you to go to the following. Stress thallium test (stress MIBI gated thallium with SPECT). This test has a sensitivity rate of more than 97% and is a very useful test. MRI brain - in case of any thrombus or ischemic area (compromised blood supply), it would locate it. I would like to know have you done all these tests as a part of preventive checkup. Secondly, is there any history of CAD or stroke in your family before 55 years of age? What is your anxiety level and sleep cycle? Anxiety is a major risk factor for CAD and stroke. Also, how is your lifestyle, either sedentary or moderate?
Investigations to be done:
Do CBC (complete blood count), KFT (kidney function test), LFT (liver function test), TMT, 2D echocardiogram yearly and lipid profile every third month.Treatment plan:
Take Tablet Atorlip F 10/160 mg. Exercise for 45 minutes every day. Follow lifestyle modification, yoga or swimming, low fat diet using three types of oil for cooking by altering them every month.Regarding follow up:
Revert back after three months to a cardiologist online.