A 43-year-old white man was diagnosed with hyperlipidemia at age 13 years, when

Question

A 43-year-old white man was diagnosed with hyperlipidemia at age 13 years, when his father died of a myocardial infarction at age 34 years. The man's grandfather had died at age 43 years, also of a myocardial infarction. Currently, the man is active and asymptomatic with regard to CHD. He is taking 40 mg of lovastatin (Mevacor), 2 times/d (maximum dose). He had previously taken niacin but could not tolerate it because of flushing and gastrointestinal distress, nor could he tolerate cholestyramine resin (Questran). His physical examination is remarkable for bilateral Achilles tendon thickening/xanthomas and a right carotid bruit (Case Study Table 15-3.1). What is his diagnosis? Does he need further workup? What other laboratory tests should be done? Does he need further drug treatment? If so, what?

Explanation / Answer

From the above observation it can be noted that his triglycerides are fine, total cholestrol level is high. It would be preferable to ask him to check his HDL-C levels as it is high as well, warn him that his LDL -C is very high. Alkaline phosphatase is the normal range however the ASP/ALT is in a high ratio proving that there might be damage to the liver and hence further screening for bilirubin and biliverdin tests can be carried out and even liver function tests such as SGOT and SGPT to further rule out cirrhosis. To reduce the ASP/ALT levels medication will be need to be prescribed such as Pioglitazone

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