From the Guidelines
For a 67-year-old male with a family history of cardiovascular disease, hyperlipidemia, and stroke concerns, one-time abdominal aortic aneurysm screening via ultrasound is recommended as he is a male between 65-75 years old. This recommendation is based on the USPSTF guidelines, which suggest that screening for abdominal aortic aneurysms is appropriate for men aged 65 to 75 years who have ever smoked, and also consider screening appropriate in men with a first-degree relative with an abdominal aortic aneurysm 1.
Given his high-risk profile, several other key screenings are also recommended:
- Blood pressure screening should be performed at least annually, with a target of less than 130/80 mmHg, as recommended by the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1.
- Lipid screening is essential, with follow-up every 1-5 years depending on risk factors, aiming for LDL levels below 55 mg/dL, as recommended by the 2024 ESC guidelines 1.
- Annual screening for type 2 diabetes with fasting glucose or HbA1c testing is advised due to his cardiovascular risk factors.
- The USPSTF also recommends discussing aspirin prophylaxis (typically 81 mg daily) after weighing bleeding risks against cardiovascular benefits, as stated in the 2017 USPSTF recommendation statement on statin use for the primary prevention of cardiovascular disease in adults 1.
- A discussion about lifestyle modifications is crucial, including smoking cessation if applicable, maintaining a Mediterranean or DASH diet, regular physical activity (150 minutes of moderate exercise weekly), and limiting alcohol consumption, as recommended by the 2024 ESC guidelines 1.
These screenings and interventions are particularly important given his family history and hyperlipidemia, which significantly increase his risk for cardiovascular events and stroke.
From the Research
Screening Recommendations
Based on the provided evidence and the USPSTF guidelines, the following screening is recommended for a 67-year-old male with a family history of cardiovascular disease, hyperlipidemia, and a concern for stroke risk:
- Abdominal aortic aneurysm (AAA) screening is recommended for men of certain ages who have ever smoked 2, 3, 4, 5.
Rationale
The patient's age, family history of cardiovascular disease, and hyperlipidemia put him at increased risk for AAA and stroke.
- The USPSTF recommends one-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked 2, 3, 4, 5.
Additional Considerations
- The patient's current medical condition, hyperlipidemia, is being managed with rosuvastatin, which may have benefits beyond lipid lowering, such as reducing inflammation and stabilizing plaques 3, 6.
- Aspirin use has been associated with decreased thrombus sac volume in abdominal aortic aneurysms, which may be beneficial for this patient 5.