satyaking
Forum Junior
Topics: 5
Posts: 58
|
Which of the following patients is the best candidate for life style modification alone rather than lipid lowering medications.?
A. a 40yr.old man with a recent MI: Cholesterol 201,HDL 47.and LDL 138
B. a 62 Yr. old Diabetic man:Cholesterol 235,HDL 27 and LDL 146
C. a 57yr asymptomatic woman:Cholesterol235, HDL 92, and LDL 103
D. a 39yr old man with nephrotic syndrome: Cholesterol 285,HDL 48, LDL 195
|
| cyra
Moderator
Topics: 29
Posts: 844
|
C
|
| stepkiller
Forum Junior
Topics: 0
Posts: 36
|
C
|
| chemamr
Forum Hero
Topics: 703
Posts: 4,463
|
isn't it B?
___________________
Any time something is written against me, I not only share the sentiment but feel I could do the job far better myself.
|
| achilles
Forum Guru
Topics: 88
Posts: 1,220
|
i'd go for C too...what's the answer satyaking
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
| satyaking
Forum Junior
Topics: 5
Posts: 58
|
Well the answer is C,
see chemamr,We can evaluate risk of a patient with Hyperlipidemia developing heart disease by following risk factors
Smoking,Hypertension,HDL<45,Family history of death due to premature heart disease is men age< 55. Female age < 65 , Age of the person male>45 & female > 55.
< 2 risk factors -Life style modification required,Target goal LDL < 160
>2 + Lfestyle modifications + statins(If not controlled by modifications),Target goal LDL< 130
High risk patients LDL Goal < 100
Comming to Ques . B Patient is witjh Diabetes,Now a days patient with diabetes is takenas one with impending heart disease,Hence he comes under high risk group,hence statins are administered for him
Hope,Iam clear about it
|
| chemamr
Forum Hero
Topics: 703
Posts: 4,463
|
i think my mistake was because i had the previous guidelines, i have just checked the new ones. Thanks satyaking.
___________________
Any time something is written against me, I not only share the sentiment but feel I could do the job far better myself.
|
| chemamr
Forum Hero
Topics: 703
Posts: 4,463
|
Let me check if iīm right, ok?
A. a 40yr.old man with a recent MI: Cholesterol 201,HDL 47.and LDL 138 = Drug therapy
B. a 62 Yr. old Diabetic man:Cholesterol 235,HDL 27 and LDL 146 = TLC and/or Drug therapy
C. a 57yr asymptomatic woman:Cholesterol235, HDL 92, and LDL 103 = Remeasure in 1 year
D. a 39yr old man with nephrotic syndrome: Cholesterol 285,HDL 48, LDL 195 = Drug therapy
___________________
Any time something is written against me, I not only share the sentiment but feel I could do the job far better myself.
|
| achilles
Forum Guru
Topics: 88
Posts: 1,220
|
satyaking do you have the table(with details of all the cut offs on when to start lifestyle modifications and drugs) which is given in UW...i think we can post it here...it will be good for everyone.
if i can get it i will post it here.it helps to solve any question that we will get on this topic and we do usually get one question on this topic in the exam always.
pls if anyone has the table pls post it here.
good question satyaking.
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
| achilles
Forum Guru
Topics: 88
Posts: 1,220
|
i found this text in an american journal which gives the current ATP ( adult treatment panel ) III guidelines ... i though this might interest you all so i am posting it here.
SCREENING GUIDELINES:
We have summarized below the current national recommendations. These recommendations need to be modified for individual patients.
The rationale for screening for cholesterol problems rests on the observations that there is a direct relationship between cholesterol level and the risk of heart attacks and that lowering levels (at least in high-risk patients) leads to a reduction in heart attacks. More recently, other problems related to arteriosclerosis such as stroke have also shown to be correlated with cholesterol levels. As a result, screening should be done at least once every five years for all persons age 20 and over.
On May 15, 2001 the National Cholesterol Education Program issued their Adult Treatment Panel (ATP) III guidelines which significantly modified older treatment recommendations. For example, no longer is it adequate to screen solely with the use of a total and HDL cholesterol on non fasting samples. The current recommendation is to do a complete lipid profile. The total lipid panel contains a measurement of total cholesterol, HDL cholesterol, triglycerides and a calculation of LDL cholesterol & is done after a 9 to 12 hour fast. Normal values for Total Cholesterol are no longer given by the ATP III guidelines but are included below based on older recommendations.
Total Cholesterol: stratified according the following criteria: - Desirable below 200 mg/dL Borderline high 200 to 239 mg/dL High above 240 mg/dL
HDL Cholesterol: "Good Cholesterol"; it is a negative risk factor for heart attack and is stratified according the following criteria: - Very High above 75 mg/dL (associated with the "longevity syndrome") High above 60 mg/dL (allows the subtraction of one other risk factor) Normal 40 to 60 mg/dl in men & women Low less than 40 mg/dl
Triglycerides: "Blood fats"; they are not directly associated with vascular disease but higher levels are associated with lower HDL values & are often associated with glucose intolerance. They are stratified according the following criteria: - Normal below 150 mg/dL Borderline high 150 to 199 mg/dL High 200 to 499 mg/dL Very High above 500 mg/dL
LDL Cholesterol: "Bad cholesterol" and is stratified according to the following criteria: - Optimal - below 100 mg/dl Near Optimal - 100 to 129 mg/dl Borderline High - 130 to 159 mg/dl High - 160 to 189 mg/dl Very High - greater than 190 mg/dl
TREATMENT GUIDELINES:
LDL Cholesterol
Older recommendations were based on Primary & Secondary prevention of coronary artery disease and separated people into those with (secondary prevention) & without (primary prevention) a previous heart attack. The ATP III recommendations are based on the calculation of a 10 year risk of having a heart attack. The treatment groups are divided into those persons at very high risk (10 year risk of > 20%), persons with moderate risk (10 year risk of < 20%) and persons with low risk. 1) High Risk Group. These persons are defined as having had a prior heart attack or as having a heart attack equivalent condition. Heart attack equivalent conditions include diabetes, symptomatic cerebrovascular, peripheral vascular disease, an abdominal aortic aneurysm or a 10 year risk > than 20% as calculated by the Framingham Risk Tables. The LDL goal in this group is less than 100, Life style modification is begun over 100 & drugs are recommended above 130. 2) Moderate Risk Group: These persons have 2 or more major additional risk factors. The major additional risk factor list includes: - Male above 45 years of age or female above 55 years of age. Family history of premature CHD as defined by definite heart attack or sudden death before age 55 in father or other first-degree male relative or before age 65 in mother or other first-degree female relative. Current cigarette smoking. Hypertension, as manifested by blood pressure above 140/90 or treatment with blood pressure medications. Low HDL (< 40 mg/DL)
These persons are further divided by the Framingham Risk Tables into those having a 10 year risk of from 10 to 20% & into those having a 10 year risk under 10%. The LDL goal in the patients having a 10 to 20% risk is less than 130, lifestyle modification is begun over 130 & drug therapy is recommended above 130 to 160. In the group with a 10 year risk under 10%, the recommendations are the same except the threshold for drug therapy is increased to 160. Note: A 10 year risk calculator provided by the National Cholesterol Education Program is available for use on line. 3) Low Risk Group: These persons have 0 to 1 major additional risk factor. The major additional risk factor list includes: - Male above 45 years of age or female above 55 years of age. Family history of premature CHD as defined by definite heart attack or sudden death before age 55 in father or other first-degree male relative or before age 65 in mother or other first-degree female relative. Current cigarette smoking. Hypertension, as manifested by blood pressure above 140/90 or treatment with blood pressure medications. Low HDL (< 40 mg/DL)
Almost all persons in this group have a 10 year risk well under 10%. The LDL goal in this group is less than 160, lifestyle modification is begun over 160 & the threshold for drug therapy is 190.
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
| achilles
Forum Guru
Topics: 88
Posts: 1,220
|
The most recent guidelines, issued by the Third National Cholesterol Education Program Adult Treatment Panel (ATP III), identify low-density lipoprotein (LDL) cholesterol as the prime target for lipid intervention to prevent CVD, with optimal LDL cholesterol levels being below 100 mg/dL.[3] The medical and policy question facing physicians today is how to bring patients into compliance with these guidelines.
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
| chemamr
Forum Hero
Topics: 703
Posts: 4,463
|
good work achilles.
___________________
Any time something is written against me, I not only share the sentiment but feel I could do the job far better myself.
|
| amygdalaa
Forum Guru
Topics: 24
Posts: 399
|
Also in C th HDL of 92(>60) actually takes away one risk factor.
___________________
"If at any point you feel you cant..... then you MUST"
|
| chemamr
Forum Hero
Topics: 703
Posts: 4,463
|
___________________
Any time something is written against me, I not only share the sentiment but feel I could do the job far better myself.
|
| achilles
Forum Guru
Topics: 88
Posts: 1,220
|
hey chemamr good to have you back...
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
|
| |
| | | | | | | | | | | | | | | |
