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November 1, 1995

A 79-Year-Old Musician With Asymptomatic Carotid Artery Disease

JAMA. 1995;274(17):1383-1389. doi:10.1001/jama.1995.03530170063034

Dr DALEY: Mr C, a 79-year-old married professional classical musician with a history of cardiovascular and peripheral vascular disease, was noted to have asymptomatic carotid bruits in March 1995. He is active as a teacher and performer. He is insured by Medicare and carries supplemental Medigap insurance.

In 1989, Mr C underwent coronary artery bypass grafting for progressive anginal symptoms. Angina recurred in December 1994, and cardiac catheterization revealed diffuse three-vessel coronary artery disease with patent grafts. In recent months his angina has abated with medical therapy.

His risk factors for atherosclerosis include a total cholesterol level of 6.18 mmol/L (239 mg/dL), a family history of coronary artery disease, and a history of smoking cigarettes 20 years ago. Current medications include amlodipine besylate, 5 mg daily; terazosin hydrochloride, 5 mg daily, for mild symptoms of prostatic hypertrophy; and one enteric coated aspirin daily. Hypercholesterolemia is managed by diet, although until

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