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A 58 year old man presents to his general practitioner (GP) to discuss recent blood test results after his annual review for hypertension. His medical history includes gout, chronic kidney disease stage G3a, prediabetes, and dyslipidaemia. His body mass index is 35. He takes ramipril 2.5 mg daily for hypertension and chronic kidney disease and rosuvastatin 10 mg daily for dyslipidaemia. He smokes five cigarettes a day and drinks three pints of beer each night. He works as a car salesman, and has not travelled overseas in the past two years.