Patient Story: Tom is a 52-year-old married man with two children. He was a manufacturing supervisor from Co Clare who retired prematurely after an industrial accident.
He first came to his GP with a request for Viagra tablets to help with impotence problems.
Although he had had a heart attack 15 years previously in Britain, he had not been followed up medically, despite having a high cholesterol level at the time of his coronary problems.
Tom's new GP went through his cardiac risk factors: a non-smoker, he was lean with a normal body mass index.
With no family history of cardiac disease, his blood pressure was 140/80 (normal).
However, his blood cholesterol level was extremely high at 10.5 mmol/litre. And, of course, he had a personal history of cardiac problems.
He was immediately started on cholesterol-lowering therapy. It was not until the third type of statin tablet was tried at its highest dose that his cholesterol came down to acceptable levels. Tom was also prescribed aspirin to reduce the increased risk of a further heart attack or stroke.
He attended a dietician who gave detailed advice on a cholesterol-lowering diet.
He was not prescribed another preventive agent - a beta blocker - because of his impotence problems, which could be worsened by this medication.
Tom is a fastidious person who sticks to his diet and exercise regimes.
He faithfully attends cholesterol testing every six months and is medically reviewed once a year.
Three and a half years later he remains stable. He continues to take Viagra, which has not caused any cardiac side-effects.