risk is the overall risk of CVD resulting from the presence of the metabolic syndrome, and also of traditional risk factors such as high LDL/low HDL, high blood pressure, high blood glucose, increasing age, male gender, smoking, and other unknown risk factors such as genetic factors.

A46-year-old man with a history of hypertension and hypercholesterolemia visits the physician for a routine followup. the patient's job involves a lot of travelling, and he admits to occasionally forgetting to take his medications with him when he travels. he complains of several episodes of chest pain in the past few months. the pain is sharp in nature, mainly over his lower chest and epigastrium, and tends to come on when walking. he believes these episodes are due to indigestion and has been taking antacids. there is a family history of heart disease, and his father died of a heart attack at age 48. on physical examination, his blood pressure is 150/80 mmhg and heart rate is 86/min. his lungs are clear to auscultation. cardiac auscultation reveals normal rate and rhythm, without rubs, gallops, or murmurs. there is no pedal oedema. he is sent for an exercise stress test. five minutes into the test, he develops st depression of 3mm in leads v1-v5. the st segment depression is greater than 0.12 seconds in duration and the stress test is stopped. which of the following is the most appropriate next step in management? - coronary angiography- holter monitor- no further tests are required- repeat stress test with thallium- upper gastrointestinal endoscopy