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Lipids

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young_doc
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04/27/07 - 04:48 PM

12. A 56-year-old woman comes to the office to discuss the results of her recent lipid panel. She has no personal or family history of premature coronary artery disease. She has hypertension, which is well controlled with atenolol, 50 mg/d. She is a nonsmoker and has no history of diabetes mellitus or vascular disease. Her serum total cholesterol is 240 mg/dL, with high-density lipoprotein cholesterol of 68 mg/dL and triglycerides of 148 mg/dL. Her calculated low-density lipoprotein cholesterol is 142 mg/dL. Her blood pressure is 132/82 mm Hg.

What is the most appropriate initial management of this patient's hyperlipidemia?

( A ) Lifestyle changes
( B ) Atorvastatin
( C ) Cholestyramine
( D ) Gemfibrozil
( E ) Niacin

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vradojc1
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04/27/07 - 05:04 PM

2 risk factors: female>55, HTN with medication
Target is LDL<130. So Atorvastatin - B

doc_clotaire
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04/27/07 - 05:49 PM

Without CHD or family history of CHD , patient has only 2 risks factor , Recommendation to start therapy is with LDL more than 160 , This patient 's LDL is only 142

I would go for A first

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Justice
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04/27/07 - 05:58 PM

vradojc1 wrote:
2 risk factors: female>55, HTN with medication
Target is LDL<130. So Atorvastatin - B

All of these minus HDL >60... So, the Pt has 1 risk factor
(A)

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vradojc1
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04/27/07 - 05:59 PM

Sorry, I missed "initial". She needs lifestyle changes first.

Aashi
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04/27/07 - 06:04 PM

she has 2 RISK factors----->that is her age and HTN on drugs

BUT her HDLis --------> > 60 is considered as 'NEGATIVE' risk factor and its presence removes one risk factor from the total count of risk factors( according to NCTP adult t/t panel III guidelines)----------> so just 1 risk factor--------->therfore the LDL goal is 160, and > 190 we start drugs, currently her LDL is 142-------------->so start with LIFE STYLE MODIFICATION------->A

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young_doc
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04/28/07 - 12:21 PM

Ans: A

" This woman has no coronary artery disease equivalent (diabetes mellitus, abdominal aortic aneurysm, symptomatic peripheral artery disease, or coronary artery disease). Hypertension is her only risk factor, and a high-density lipoprotein cholesterol level greater than 60 mg/dL is a negative risk factor. Therefore, for the purposes of determining whether she is a candidate for lipid-lowering therapy, she has 0 to 1 risks (these risks are independent of the low-density lipoprotein [LDL] cholesterol level). Intervention should be pursued for a serum LDL cholesterol level greater than 160 mg/dL, with medication recommended if the level is greater than 190 mg/dL and optional if the level is between 160 and 189 mg/dL. There are no data on the benefit of lipid-lowering treatment with medication in this low-risk population. "

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ram3
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06/04/07 - 02:35 PM

Lifestyle changes Big Time

cirus
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06/07/07 - 10:45 AM

Agree---> life style modific

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