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 high cholesterol levels  



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Author6 Posts
  #1

case 1

55 yo male
H/O - chronic stable angina for 10 yrs; smoked 1 pack of cigarettes for 20 yrs until 12 yrs ago; otherwise unremarkable.
comes to you for a routine check up
you find a total CT of 280 and HDL - CT of 45

what next? (in terms of unvestigations and management)


case 2

40 yo female
H/O - non-smoker, no alcohol consumption, denies taking illicit or over - the - counter drugs; cholecystectomy at age 35, otherwise unremarkable
comes to you for a routine check up
you find a total CT of 190 and HDL -CT of 34

what next? (in terms of investigation and management)


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  #2

Case 1
1. Do risk strtification- as the Risk Factor is just age and stable angina here but the cholesterol level is > 190 so start with
A] Statins
B]Theraputic lifestyle change
Target LDL in these pt is <100
Every pt >20 ys with risk factor[of cad] has to go for LDL level evaluation every 5 yrs in case of hypercholestremia


  #3

Case2
Do just theraputic lifestyle modification i.e 12 week trial of diet ,exercise and wt loss.


  #4

Tnx Dot. Here's the correct answer:

case 1

55 yo male
H/O - chronic stable angina for 10 yrs; smoked 1 pack of cigarettes for 20 yrs until 12 yrs ago; otherwise unremarkable.
comes to you for a routine check up
you find a total CT of 280 and HDL - CT of 45

what next? (in terms of unvestigations and management)

The pt. has 3 risk factors: age, CAD, smoking. Total CT is very high; To be truly cardioprotective, HDL-CT should be >60. In this case, the HDL-CT levels are not cardioprotective. In fact, according to some medical textbooks, a HDL-CT level below 60 is considered a risk factor more important than a high LDL-CT.
Since there are 3 risk factors, a high total CT and a non-protective HDL-CT, it is reasonable to think seriously of treating this pt. However, it's reasonable to allow a 3-6 mo period of lifestyle modification (diet - decrease saturated fat / salt intake, physical exrecise, stress reduction, stop smoking, decrease alcohol cosumption - alcohol in excess causes a further reduction in HDL-CT). If, after this period, there is no significant improvement, start medication - the drugs used are according to the patient's general health status / other diseases)

case 2

40 yo female
H/O - non-smoker, no alcohol consumption, denies taking illicit or over - the - counter drugs; cholecystectomy at age 35, otherwise unremarkable
comes to you for a routine check up
you find a total CT of 190 and HDL -CT of 34

what next? (in terms of investigation and management)

Despite cholecystectomy (gallbladder stones - most made of cholesterol), there is no significant risk factor for this pt.
The total CT is below 200 - but the HDL-CT is very low. So, the next most logical thing to do is to calculate LDL-CT. If normal levels, we should remeasure CT levels in 3-5 yrs (the TG levels may be high, but high TG levels alone is not considere a risk factor); if high - advise about lifestyle modification first; if this fails - start medications.

Hope it helped.


  #5

Thanx miky.I thought that as the pt has left smoking 10 yrs back it is no more a risk factor.And ab HDL it is said that only <40 can be cosidered as risk factor.


  #6

Dear Dot,

The patient heavily smoked for quite a while (2o yrs) :wink: . Even if he quit smoking, considerable damage has been presumably already caused :wink: . It's very unlikely that his body might not be affected :roll: . CAD suggests that. A heavy smoker is a heavy smoker. This is an important risk factor. You must therefore consider it. Of course, as you said, it's not present at the time of history taking, but we should pay some attention to it :idea: .





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