Should a 52-year-old asymptomatic former smoker with normal blood pressure, hemoglobin A1c (HbA1c) 5.4%, BMI 29 kg/m², HDL cholesterol 50 mg/dL, LDL cholesterol 92 mg/dL, total cholesterol 104 mg/dL, and low 10-year atherosclerotic cardiovascular disease (ASCVD) risk undergo abdominal aortic aneurysm screening or carotid artery ultrasound?

No Additional Testing is Recommended

This 52-year-old asymptomatic male who quit smoking 30 years ago does not meet criteria for either abdominal aortic aneurysm (AAA) screening or carotid artery ultrasound, and therefore no additional testing should be performed at this time.

Abdominal Aortic Aneurysm Screening - Not Indicated

The U.S. Preventive Services Task Force provides clear age-based and smoking-related criteria for AAA screening that this patient does not meet:

• AAA screening is inappropriate for individuals under age 65 with no history of smoking 1
• The patient is only 52 years old and quit smoking 30 years ago, placing him well outside the recommended screening window 1
• The USPSTF recommends one-time screening for men ages 65-75 who have ever smoked (Grade B recommendation), but this patient has not yet reached that age threshold 1

Family History Consideration

While the patient's father had a stroke at age 50, this does not constitute a family history of AAA:

• Screening based on family history specifically requires a first-degree relative with an AAA, not stroke or other cardiovascular disease 1
• The European Society of Cardiology recommends screening for first-degree relatives of AAA patients aged ≥50 years, but only when there is documented AAA in the family member 2
• A parental history of stroke does not trigger AAA screening criteria 2

When to Reconsider Screening

This patient should be reconsidered for AAA screening when he reaches age 65, given his remote smoking history (quit 30 years ago):

• At age 65-75, men who have ever smoked should receive one-time ultrasound screening 1
• The ACC/AHA appropriate use criteria rate screening as appropriate for men 65-75 who are current or former smokers 1

Carotid Artery Ultrasound - Not Indicated

Carotid ultrasound screening is not appropriate for this asymptomatic patient with well-controlled cardiovascular risk factors:

• Routine carotid duplex ultrasonography is not recommended for asymptomatic individuals without clinical manifestations of or risk factors for atherosclerosis 3
• The patient has no symptoms, normal blood pressure (118/78), and well-controlled metabolic parameters (HbA1c 5.4%, LDL 92 mg/dL) 3
• Carotid ultrasound is only appropriate when there are signs or symptoms such as a carotid bruit, TIA, or stroke 1

Carotid Screening Criteria Not Met

The appropriate use criteria specify when carotid imaging would be indicated:

• Presence of a carotid bruit on auscultation would warrant duplex ultrasonography 4, 3
• Symptoms of cerebrovascular disease (TIA, stroke, amaurosis fugax) would be appropriate indications 1
• This asymptomatic patient with no documented bruit does not meet these criteria 3

Risk Factor Optimization is the Appropriate Next Step

Rather than screening tests, this patient should focus on cardiovascular risk factor management:

• His BMI of 29 kg/m² places him in the overweight category, and weight reduction should be encouraged 1
• Blood pressure is well-controlled at 118/78 mmHg 1
• Lipid profile shows HDL 50 mg/dL and LDL 92 mg/dL, which are acceptable but could be optimized 1
• HbA1c of 5.4% indicates excellent glycemic control 1
• Continued smoking cessation should be reinforced 1

Common Pitfall to Avoid

Do not order screening tests based solely on family history of non-AAA cardiovascular disease or age alone without meeting specific screening criteria 1, 3. The patient's father's stroke does not constitute an indication for vascular screening in the absence of other qualifying factors such as reaching age 65 or having a family history specifically of AAA 2.