A 59-Year-Old Man Comes to the Office for Follow-Up

A 59-year-old man comes to the office for follow-up.  The patient had an acute myocardial infarction 1 month ago, and a drug-eluting stent was placed successfully.  He has no cardiovascular symptoms, but he does have hypertension and hyperlipidemia and a 40-pack-year smoking history.  Blood pressure is 132/86 mm Hg and pulse is 68/min.  BMI is 30.8 kg/m².  Physical examination is unremarkable.  The patient says, "I can't wait to get back to work, but at the same time, I'm concerned about having another heart attack.  I have a high-pressure job, but I need to find time to exercise.  Plus, I know I should stop smoking and lose at least 20 pounds."  Which of the following is the most appropriate response by the physician at this time?

A) "Having a heart attack was frightening.  It's great that you've decided to stop smoking, lose weight, and start exercising."
B) "I suggest we prioritize quitting smoking first.  That will decrease your risk significantly and make it easier to exercise."
C) "Those are excellent goals.  Let's make a comprehensive list of all the health changes you want to make."
D) "You've been through a tough time.  Would you consider working fewer hours for the time being so you can focus on your health?"
E) "You've brought up important issues.  What are one or two small changes you feel most ready to tackle now?"

Correct Answer:

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