A 65-year-old musician with type 1 diabetes mellitus was referred to the cardiology department for shoulder pain, which he had experienced while pushing his double bass on the way to a performance. The patient, who exercised regularly, had not had chest pain, shortness of breath, or palpitations. He had a 25-pack-year history of tobacco use but had quit 14 years earlier. He had no family history of coronary artery disease. Results of electrocardiography and echocardiography showed nothing of note. His high-density-lipoprotein cholesterol level was 83 mg/dL, and low-density-lipoprotein cholesterol was 87 mg/dL.
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