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Case Study

Case Study

Patient History
68 year old male in excellent health entered for initial lipoprotein evaluation. His cardiovascular history was significant for a short history of high blood pressure, controlled easily with medicine. He is very active and plays golf 3 times a week and goes to the gym 3 times a week.

His Past Medical History Current medicines Physical Exam
  • High blood pressure
  • Lipitor 10mg per day
  • Atenolol 50mg per day
  • Baby aspirin
  • Vitamins
BP 128/78
P 64
RR 16
Exam otherwise unremarkable.


Lipid panel at presentation Status Recommendations
Total cholesterol 195mg/dL
LDL cholesterol 98mg/dL
HDL cholesterol 45mg/dL
Triglycerides 210mg/dL
  1. Multiple risk factors for heart disease (high blood pressure, age) 10 year Framingham risk of cardiac event- 16%
  2. LDL-C goal< 130mg/dL
  1. Encourage therapeutic lifestyle changes
  2. No intervention with drugs needed at this time
Per the status and recommendations from National Cholesterol Education Panel (NCEP). Launched by the National Heart Lung and Blood Institute with the goal to reduce the prevalence of high blood cholesterol in the U.S. and contribute to the reduction of mortality due to coronary heart disease in the U.S.

NMR-Based Lipoprotein Testing Results Medicine changes made 8 weeks after therapy
    Goal
LDL-P 1558 nmol/l < 1000
Small LDL-P 928 nmol/l < 700
Large VLDL 135 mg/DL < 7
Large HDL 13 mg/DL > 30
Small Size
  1. Stop Lipitor
  2. Start Crestor 10mg per day
  3. Start Zetia 10mg per day
  4. Start Tricor 145mg per day
  5. Start Omega 3 fatty acids 3 grams per day
  6. Dietary fiber
  7. Benecol spread
LDL-P 958 nmol/l
Small LDL-P 503 nmol/l
Large VLDL 7.9 mg/dL
Large HDL 28.1 mg/dL
Large Size


NMR-Based Lipoprotein Testing Summary Conclusion
Baseline 8 Weeks
LDL particle number 1558 958
Large HDL 13 28.1
Large VLDL 135 7.8

  1. Despite NCEP recommendation of no treatment for this man's cholesterol, his risk of a cardiac event was 16% over 10 years.
  2. His initial lipoprofile was high risk for an event despite having "normal cholesterol"
  3. After 8 weeks of treatment with no side effects from the medication, he now has an optimal lipoprofile for coronary heart disease.

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