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Chapter 12. Dyslipidemias

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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?

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

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

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

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

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

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What is this patient’s primary target for intervention?

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A. Triglycerides

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B. LDL cholesterol

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C. Non-HDL cholesterol

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D. HDL cholesterol

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E. Non-HDL and LDL cholesterol

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

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A. She has hypercholesterolemia and is likely polygenic

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B. She has hypercholesterolemia and heterozygous familial hypercholesterolemia

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C. She has hypertriglyceridemia

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D. She has a combined dyslipidemia

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E. She has homozygous familial hypercholesterolemia

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

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A. Start simvastatin 80 mg daily

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

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C. Start ezetimibe 10 mg daily

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D. Start a high-intensity statin

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E. Start gemfibrozil 600 mg twice daily

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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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