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Chapter 12. Dyslipidemias

A 38-year-old woman presents to your clinic today with new onset chest pain that occurs after walking a few blocks. Her father had a heart attack at age 40. Her diet is low in saturated fats and cholesterol. The patient is otherwise healthy and does not smoke. Her lipid panel today is: total cholesterol 350 mg/dL (9.05 mmol/L), HDL cholesterol 40 mg/dL (1.03 mmol/L), and triglycerides 120 mg/dL (1.36 mmol/L). What is her non-HDL cholesterol and LDL cholesterol?

A. 310 mg/dL (8.02 mmol/L) and 286 mg/dL (7.40 mmol/L)

B. 390 mg/dL (10.09 mmol/L) and 334 mg/dL (8.64 mmol/L)

C. 310 mg/dL (8.02 mmol/L) and unable to calculate

D. 350 mg/dL (9.05 mmol/L) and 286 mg/dL (7.40 mmol/L)

E. 310 mg/dL (8.02 mmol/L) and 230 mg/dL (5.95 mmol/L)

What is this patient’s primary target for intervention?

A. Triglycerides

B. LDL cholesterol

C. Non-HDL cholesterol

D. HDL cholesterol

E. Non-HDL and LDL cholesterol

What is your assessment of this patient’s lipid disorder?

A. She has hypercholesterolemia and is likely polygenic

B. She has hypercholesterolemia and heterozygous familial hypercholesterolemia

C. She has hypertriglyceridemia

D. She has a combined dyslipidemia

E. She has homozygous familial hypercholesterolemia

According to the ACC/AHA guidelines, what intervention would be most appropriate for this patient?

A. Start simvastatin 80 mg daily

B. Start prescription omega-3 fatty acid esters 4 g daily

C. Start ezetimibe 10 mg daily

D. Start a high-intensity statin

E. Start gemfibrozil 600 mg twice daily

The patient returns to clinic after 4 months for follow-up and post percutaneous coronary intervention of her left anterior descending coronary artery with the following lipid panel: total cholesterol 230 mg/dL (5.95 mmol/L); triglycerides 100 mg/dL (1.13 mmol/L); HDL cholesterol 44 mg/dL (1.14 mmol/L); LDL cholesterol 166 mg/dL (4.29 mmol/L). According to the NLA guidelines, what are the non-HDL cholesterol and LDL cholesterol goals for this patient?

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