Care after coronary-artery bypass surgery.

N Engl J Med 2003;348:1456-63. Copyright © 2003 Massachusetts Medical Society. A 71-year-old woman who had a myocardial infarction five years previously and underwent coronary-artery bypass surgery six months ago visits a primary care physician. She had no complications after surgery, but intraoperative transesophageal echocardiography revealed a grade V atheroma in the descending aorta. She has no cardiac or neurologic symptoms but notes that she feels depressed and has difficulty concentrating. She had not been depressed before. Her blood pressure is 110/80 mm Hg, and her pulse is 76 and regular. The physical examination is notable only for a weight of 160 lb (72 kg) at a height of 5 ft 4 in. (1.6 m). The fasting plasma glucose level is 109 mg per deciliter (6.1 mmol per liter), the low-density lipoprotein cholesterol level is 128 mg per deciliter (3.3 mmol per liter), the high-density lipoprotein cholesterol level is 40 mg per deciliter (1.0 mmol per liter), and the triglyceride level is 200 mg per deciliter (2.3 mmol per liter). What would you advise to improve her long-term outcome?