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1.3.1: Assess and modify individualized treatment plans, considering therapeutic goals and outcomes

BT is a 47-year-old patient presenting for his annual primary care follow-up visit. BT has a past medical history significant for hypertension, atrial fibrillation, coronary heart disease, previous myocardial infarction (2 years ago), and previous stroke (1 year ago). The patient has labs drawn 2 weeks before visit (basic metabolic panel, complete blood count, lipid panel, and prostate specific antigen). The lipid panel was the only lab outside of normal limits. BT has an LDL-C of 122 mg/dl and HDL-C of 39 mg/dl. BT has a negative family and social history. Current medications include lisinopril 40 mg daily, amiodarone 200 mg twice daily, baby aspirin 81 mg daily, and atenolol 50 mg daily. BT is counseled to initiate therapeutic lifestyle changes and prescribed a medication to control the lipids. BT's primary provider consults you to select the agent to obtain BT's cholesterol target goals. What is the appropriate cholesterol target goal for BT?

(A) Less than 100 mg/dl

(B) Less than 130 mg/dl

(C) Less than 160 mg/dl

(D) Greater than 45 mg/dl

The correct answer is (A).

For high-risk patients, the National Cholesterol Education Program recommends that LDL-C be lowered to less than 100 mg/dl (A) or by at least 30-40%, but considers a value less than 70 mg/dl an optional goal for patients at very high risk. High risk patients are defined as having CHD or CHD risk equivalents (e.g., diabetes). BT has a diagnosis of coronary heart disease; therefore, his goal is less than 100 mg/dl. A high risk patient has a 10-year risk of a cardiovascular event greater than 20%.

An LDL-C less than 130 mg/dl (B) is the goal for patients at moderately high risk (patients with greater than or equal to two risk factors for CHD). An LDL-C less than 160 mg/dl (C) is the goal for patients at moderate to low risk (patients with one or less risk factors for CHD). Greater than 45 mg/dl (D) refers to HDL-C. An HDL-C goal is greater than 45 mg/dl (the higher the better).

What is the LDL-C goal for JD?

(A) Less than 100 mg/dl

(B) Less than 130 mg/dl

(C) Less than 160 mg/dl

(D) greater than 60 mg/dl

The correct answer is (A).

For high-risk patients, the National Cholesterol Education Program recommends that LDL-C be lowered to less than 100 mg/dl (A) or reduced by at least 30-40%, but considers a value less than 70 mg/dl an optional goal ...

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