Three patients are seen in clinic: * Patient one is a 40-year-old man with hyper

Question

Three patients are seen in clinic: * Patient one is a 40-year-old man with hypertension, who also smokes, but has not been previously diagnosed with CHD. His father developed CHD at age 53 years. He is fasting, and the results of his lipids include a total cholesterol concentration of 210 mg/dL, triglycerides of 150 mg/dl, and an HDL cholesterol level of 45 mg/dL. He has a fasting glucose level of 98 mg/dL. Patient two is a 60-year-old woman with no family history of CHD, who is normotensive and does not smoke, with a total cholesterol concentration of220 mg/dL, triglycerides of 85 mg/dL, and an HDL cholesterol value of 80 mg/dL. Her fasting glucose level is 85 mg/dL.. * * Patient three is a 49-year-old man with no personal or family history of CHD, and who is not hypertensive and does not smoke. His fasting total cholesterol level is 260 mg/dl, his triglycerides are 505 mg/dL, his HDL cholesterol is 25 mg/dL, and his glucose level is 134 mg/dl. Questions For each patient seen in clinic 1. What is the LDL cholesterol level, as calculated using the Friedewald calculation? 2. Which patient, if any, should have their LDL cholesterol measured, rather than calculated? Why? How many known CHD risk factors does each patient have? Based on what is known, are these patients recommended for lipid therapy (diet or drug) 3. 4. and, if so, on what basis?

Explanation / Answer

1. LDL-C can be calculated using the following Friedewald formula-

LDL-C (mg/dL) = total cholesterol – HDL-C – (triglycerides/5).

Therefore, LDL-C for each patient can be given by-

40-year old man LDL-C = 210 - 45 - 150/5 = 135 mg/dL

60-year old woman LDL-C = 220 - 80 - 85/5 = 123 mg/dL

49-year old man LDL-C = 260 - 25 - 505/5 = 130 mg/dL

2. LDL-C is recommed to be measured rathae than calculated by Friedewald Formula in patients with Triglycerides >200 and when LDL <70 or >130. In our case, there are two patients which are in suspected category

a) 40-year old man because his calulated LDL-C is > 130 mg/dL and b) 49-year old man because his Triglycerides are > 200 mg/dL.

3. CHD risk factors in patients-

40-year old man- gender (men are more likely to have CHD than women), smoking, family history of CHD, high LDL-C (border line), hypertension.

60-year old womna- age, menopause (because of reduced oestrogen level), high TC (border line).

49-year old man- gender, hypertension, high TC, very high triglycerides, high glucose level.

4. Lipid therapy (diet) should be recommended for first patient because he has several CHD risk factors but none of them seems very high risk and most of them can be managed by diet. Lipid therapy (drug) should be recommeded for third patient as he is in high risk CHD category because of elevated levels of TC, triglycerides and glucose.

Thanks!

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