Question of the Week # 50

A 50 year old woman with history of coronary artery disease and hypertension presents to your office for regular health check up. The patient is compliant with her medications which include aspirin, atorvastatin and enalapril. Her blood pressure is 110/70. Laboratory investigations including CBC and comprehensive metabolic panel are with in normal limits. A fasting lipid panel that was performed one week ago reveal an LDL cholesterol of 65, HDL of 50 and Triglycerides of 150. You discuss the results with her and you inform her that the goals of therapy are being adequately met. She seemed happy to know about the results but tells you that lately, her mood has been slightly low. There are good days but she tends to have frequent bad days as well. She enjoys surfing as she used to before. She has no weightloss and her appetite is good. She denies any suicidal ideations. She asks you if there is any medication that would benefit her heart and also, help her mood. The next best step in managing this patient is :

A. Start escitalopram
B. Start clozapine
C. Refer to psychiatrist
D. Start Omega 3 Fatty Acids
E. Start St.John’s Wort

One Response

  1. Omega 3 fatty acids are useful in improving the risk of coronary artery disease. Omega 3 fatty acids are also effective in reducin serum triglycerides and improves mood in mild to moderate depression. This is the medication that will help address ” her heart issues as well as her mood.”

    Choice. A is incorrect because the patient does not have significant depression that warrants pharmacotherapy at this time. Escitalopram also does not have any beneficial effect on cardiovascular risk.

    Choice. B is incorrect because the patient does not have pychotic depression that warrants clozapine at this time. Clozapine also increases cardiovascular risk by causing obesity, metabolic syndrome and worsening hyperlipidemia.

    Choice. C is incorrect because the patient does not have significant depression that warrants psychiatry referral at this time.

    Choice E is incorrect. St.John’s wort is useful in treating mild to moderate depression. However, St.John’s wort has no effect in improving the patient’s cardiovascular risk.

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