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PATIENT PRESENTATION

Chief Complaint

Patient was identified via population management and invited to the pharmacy clinic at a Veterans Affairs (VA) facility.

History of Present Illness

62-year-old African American male Veteran, who was identified during a clinical pharmacist review of clinical data as having high low-density lipoprotein (LDL) cholesterol without treatment. The patient was invited to meet with the pharmacist at their primary care clinic in the VA medical center for risk assessment and treatment.

Student Work-Up

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Missing Information?

Evaluate:

Patient Database

Drug Therapy Problems

Care Plan (by Problem)

TARGETED QUESTIONS

  1. What risk factors for arteriosclerotic cardiovascular disease (ASCVD) does the patient have?

    Hint: See Table 13-7 in PPP and 2018 AHA/ACC 2.1.3 & Table 6

  2. What therapeutic lifestyle changes would benefit this patient?

    Hint: See Treatment and Table 13-3 in PPP and 2018 AHA/ACC 3.1.1 and 3.1.2

  3. What is the ASCVD risk percent for this patient and what percentage of LDL lowering should you target?

    Hint: See Table 13-4 and Figure 13-5 in PPP and 2018 AHA/ACC 4.4 & Table 6

  4. Which medication would you choose for this patient, and how would you plan their monitoring and follow-up?

    Hint: See Tables 13-5, 13-9, 13-10 and Figure 13-5 in PPP and 2018 AHA/ACC 4.4 & Figure 2, 4.4.3, 5

  5. What medication education would the patient benefit from to be successful with his treatment plan?

    Hint: See Treatment and Table 13-10 in PPP and 2018 AHA/ACC 3.1.1 and 3.1.2, 6

FOLLOW-UP

What additional medication would you consider for this patient?

CASE SUMMARY

Global Perspective

Clinicians should be aware that ethnic groups may vary in their risk and presentation for chronic heart disease (CHD). While the statin family of medications has shown reductions in major adverse cardiovascular events in large trials amongst people of varying ethnicities, the majority of patients in these trials were Caucasian. Additionally, there are known racial differences in statin responses. For example, studies in Japanese and Chinese populations have shown lower atorvastatin and rosuvastatin doses were required to achieve an equivalent LDL-C lowering to that in a Western population. Specifically, the manufacturer of rosuvastatin, along with U.S. Food and Drug Administration (U.S. FDA) approval, recommends in Asian patients that the starting dose of rosuvastatin be 5 mg (instead of 10 mg). This is based on pharmacokinetics studies showing an approximate 2-fold increased exposure to rosuvastatin in Asian patients compared with Caucasians. While hypotheses suggest pharmacokinetic or genetic influences that could explain these findings, further research is necessary to fully elucidate the ...

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