Shohei Tamai is a 57-year-old director of athletic programs at a women's junior college in Shikoku. He has come to your office to seek help because of recent changes in his health. For the past few months Patient Tamai has been feeling tired, and more recently he seems to become thirsty far more often, drinking colas, coffee and tea many times during the work day, and lots of beer in the evening. He also tells you he's been under a lot of pressure in his workplace lately, having to work long hours five, six and sometimes seven days a week during sports competitions involving his students at the junior college.

Mr. Tamai is really most concerned about the numbness in his legs which often occurs during the middle of his work day. His blood pressure is 155-95 mm Hg. and you have measured his BMI as 32. Mr. Tamai's LDL is 176 mg/dl; HDL is 30 mg/dl. Additionally, Mr. Tamai tells you that he is much more irritable lately, that he sometimes gets angry with his students and family members with little or no provocation.

Mr. Tamai has no clear idea what causes his fatigue, anger or numbness. But it seems clear that the preliminary data on this patient as well as the patient's personal and family histories put him in some danger of developing a serious heart condition. In talking with Mr. Tamai you have learned that both his mother and father have died of heart disease. Further, while Patient Tamai helps young people in their athletic exercises, because he is the only man in the gymnasium he himself does little or no exercise. In addition, he is a heavy smoker and he has poor eating habits, preferring to consume fatty meats such as pork, spare ribs, and steak as well as fried eel and fish. His grain intake consists of mostly white rice of the Japanese variety. And when he has a chance to eat breakfast, he prefers continental-style light fare, croissants and coffee and sometimes one or two fried eggs.