Case Studies in the Management of Hyperlipidemia Case #1 Case ...

What Therapeutic ApproachWould You Start WithA. Rosuvastatin 20 mg dailyB. Atorvastatin 40 mg and Fenofibrate 160 mgDailyC. Simvastatin 40 mg and Niaspan 1000 mgDailyD. Rosuvastatin 20 mg and Omega-3 Fish Oil4 g DailyFollow-Up Labs at 3 MonthsA. FBS 118B. TC 156, HDL-C 49, LDL-C 79,TG 140C. TSH 4.020, Free T4D. Uric Acid 9.1What Therapeutic Approach isNextA. Increase Simvastatin to 80 mg andNiaspan to 2000 mg dailyB. Add Zetia 10 mg dailyC. Add WelChol 6 tablets dailyD. Switch to Rosuvastatin 40 mg andadd Omega-3 fish oil 4 g dailyCase #2• 55 Year old female who has a strong family historyof coronary artery disease and Diabetes Mellitus buthas no known disease herself. She denies anycardiovascular symptoms. She went throughmenopause at 49 and has been on HRT since.• PMH: History of elevated BS not treated, elevatedcholesterol not treated• FH: Father died sudden death at 46, brother 48 s/pPTCA and stent, sister 52 with DM andHyperlipidemiaCase #2• SH: Smokes ½ PPD, 1-3 beers per day, noexercise, diet high in meat, fat, sugar and salt• Medications: Prempro 0.45/1.5 mg daily andmultivitamin daily• PE: BP 148/96, P 78, Weight 224, Height 64inches, Fundi show mild arteriolar narrowingand increased light reflex, soft right carotidbruit, Gr 3/6 harsh SEM at the LLSB thatradiates to the base, S4, bilateral decreaseddistal pulsesCase #2• Baseline Labs: FBS 136, TSH 5.208, Cr 1.3,BUN 26, Uric Acid 9.1, TC 256, HDL-C 36,TG 564