Vascular Risk Assessment

Below you will find case histories on 2 individuals (these are real clients that I've seen in the past
couple of years). Based on the information provided, how do you assess the risk for cardiovascular
disease in each individual? Who do you believe has the greater cardiovascular risk and why?
What further assessments and recommendations might be appropriate for each?

Case # 1 RM is a 50-year-old male who is 6 feet tall and weighs 305 pounds. He has marked
central obesity and a sedentary lifestyle. His diet is primarily "meat and potatoes" with a large
amount of fast food. Lab results as follows:
glucose 88 mg/dl
cholesterol 195 mg/dl
triglycerides 87 mg/dl
HDL 59 mg/dl
LDL 119 mg/dl
Blood pressure 125/85

Case #2 LC is a 49-year-old female who is 5 feet tall and weighs 100 pounds. She runs 3 to 4
miles daily and tries to eat a "healthy" diet, including many vegetables, beans, fish, and lean meat.
Lab results as follows:
glucose 93 mg/dl
cholesterol 214 mg/dl
triglycerides 51 mg/dl
HDL 77 mg/dl
LDL 127 mg/dl
Blood pressure 115/70
Both individuals are nonsmokers.
______________

I reviewed the risk as calculated by the Framingham Coronary Prediction algorithm and
summarized here:

Case 1 has the higher calculated risk before taking into account a very high BMI, as well as a
likely hip-waist ratio that also makes him at risk. I agree with Miranda's observation about Case
2 where the intake of calories may not match the physical demands she is placing on her body
which can lead to hypothyroid and high TC. I know several long distance runners who have run
into health issues with cardiac arrhythmia related to the bradycardia. Case 1 to lower risk needs
to be more active and be more particular about diet choices. One could argue that hypothyroid
concerns are present in Case 1 exercise/diet choices showing up with borderline elevated TC.
Fast foods can be laden with rancid (old) vegetable oils which can suppress thyroid by multiple
mechanisms. (1) Additionally, overeating muscle meats tends to lead to imbalance between
more phosphate and less calcium which can activate parathyroid hormone. (2)

Sources:
(1) Tom Brimeyer. The Worst Food for Your Thyroid. 4/25/18.
http://www.forefronthealth.com/worst-food-thyroid/ (http://www.forefronthealth.com/worstfood-
thyroid/)
(2) Kemi, V.E., Kärkkäinen, M.U.M., Rita, H.J., Laaksonen, M.M.L., Outila, T.A., Lamberg-
Allardt, C.J.E., 2010. Low calcium:phosphorus ratio in habitual diets affects serum parathyroid
hormone concentration and calcium metabolism in healthy women with adequate calcium
intake. British Journal of Nutrition 103, 561. https://doi.org/10.1017/S0007114509992121
(https://doi.org/10.1017/S0007114509992121)