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
Multiple risk factors for heart disease (high blood pressure, age) 10 year Framingham risk of cardiac event- 16%
LDL-C goal< 130mg/dL
Encourage therapeutic lifestyle changes
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
1621 nmol/l
< 1000
Small LDL-P
928 nmol/l
< 700
Large VLDL
135 mg/DL
< 7
Large HDL
13 mg/DL
> 30
Small Size
Stop Lipitor
Start Crestor 10mg per day
Start Zetia 10mg per day
Start Tricor 145mg per day
Start Omega 3 fatty acids 3 grams per day
Dietary fiber
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
1621
958
Large HDL
13
28.1
Large VLDL
135
7.8
Despite NCEP recommendation of no treatment for this man's cholesterol, his risk of a cardiac event was 16% over 10 years.
His initial lipoprofile was high risk for an event despite having "normal cholesterol"
After 8 weeks of treatment with no side effects from the medication, he now has an optimal lipoprofile for coronary heart disease.
