Chapter 14: Dyslipidemia: Afraid of Another Attack Level II

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LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

• Identify patients who require treatment for dyslipidemia.

• Stratify individual patients for risk of coronary heart disease (CHD) and stroke.

• Determine appropriate LDL and non-HDL goals and thresholds based on individual risk factors.

• Recommend a cholesterol management strategy that includes therapeutic lifestyle changes (TLC), drug therapy, patient education, and monitoring parameters.

PATIENT PRESENTATION

Chief Complaint

“I am here to see if I need additional meds.”

HPI

Thomas Smith is a 52-year-old man who presents to pharmacotherapy for optimization of risk reduction therapy clinic by referral from his primary care provider following an ST-elevation myocardial infarction (STEMI) 6 months ago. He reports good adherence to his medications since having his heart attack.

PMH

Obesity (BMI 30.5 kg/m²)

Dyslipidemia × 6 years

HTN × 10 years

Chronic kidney disease (stage 3) × 5 years

CAD, s/p STEMI 6 months ago (drug-eluting stents placed in right circumflex and left anterior descending arteries)

GERD × 5 years

FH

Father: age 72 with MIs at age 50 and again at age 60

Mother: age 70 with no major medical conditions noted

Patient has one older brother age 55 with HTN and a history of one MI at the age of 48.

He has no children.

SH

Patient is married and lives with his wife.

College graduate, works as an accountant.

Admits to drinking one to two beers most days of the week and has never used tobacco.

Exercise regimen has increased since his MI; currently rides the bike at the gym for 30 minutes 2–3 days a week.

Meds (Per medication fill history)

Carvedilol 25 mg PO BID

Atorvastatin 80 mg PO once daily

Aspirin 81 mg PO once daily

Clopidogrel 75 mg PO once daily

Pantoprazole 40 mg PO once daily

Lisinopril 40 mg PO daily

Chlorthalidone 25 mg PO daily

Acetaminophen 500 mg, one to two tablets PO PRN every 6 hours for pain

Garlic capsules

All

No known drug allergies

ROS

Patient states that he had a heart attack ...