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51 Year Old Female with Family History of Premature Heart Disease and High Triglycerides

51 Year Old Female with Family History of Premature Heart Disease and High Triglycerides. Case Categories Primary Prevention Secondary Prevention Pediatric Case Familial Hypertriglyceridemia Diabetes Metabolic Syndrome Low HDL Familial Combined Hyperlipidemia

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51 Year Old Female with Family History of Premature Heart Disease and High Triglycerides

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  1. 51 Year Old Female with Family History of Premature Heart Disease and High Triglycerides Case Categories Primary Prevention Secondary Prevention Pediatric Case Familial Hypertriglyceridemia Diabetes Metabolic Syndrome Low HDL Familial Combined Hyperlipidemia Familial Hypercholesterolemia Elevated Lipoprotein (a) Statin Intolerance Case category: Familial Hypertriglyceridemia, Metabolic Syndrome History of present illness: 51 year old female with family history of premature heart disease and history of gestational diabetes. During a recent hospital admission for severe pancreatitis, glucose was abnormal and triglycerides were >9000. Started gemfibrozil. Is here for evaluation and recommended therapy.

  2. Patient Information

  3. Patient History

  4. Current Medications

  5. Lipid Profile Fasting: Unspecified NT = Not Tested

  6. Other Labs Worth Noting Fasting: Unspecified NT = Not Tested

  7. Labs

  8. NMR LipoProfile Insert NMR Lipoprofile 031611 JR59 Insert Page 1 Insert NMR Lipoprofile 031611 JR59 Insert Page 2

  9. NMR Interpretation

  10. Questions to Consider Question 1 Question 2 Question 3 Question 4

  11. Initial Treatment & Management • Continue gemfibrozil. • Start Lovaza 4 g/day to lower triglycerides. • Recommend CIMT.

  12. Discussion (1 of 2) Risk Factors: Premature family history of heart attack / stroke, Metabolic Syndrome, Low HDL, Hyperlipidemia Assessment: Familial Hypertriglyceridemia

  13. Discussion (2 of 2) Assessment: Metabolic Syndrome / Impaired Fasting Glucose

  14. Follow Up on Gemfibrozil 1200 and Lovaza 4 • Familial Hypertriglyceridemia – Improved. • Currently taking gemfibrozil 1200 and Lovaza 4. • Triglycerides lowered from 303 to 63. Excellent improvement. • LDL-P lowered from >3500 to 2189. LDL-C reduced from 246 to 180. Small dense LDL-P dropped from 2466 to 140. HDL increased from 38 to 75. Total cholesterol dropped from 345 to 168. IR Score lowered to 12 from 60. • Treatment options include adding a statin and/or changing to a low carb diet and increasing exercise. • Continue current therapy. • Metabolic Syndrome / Impaired Fasting Glucose – Improved. • HbA1c is stable at 5.6. IR-score improved from 68 to 12. Fasting glucose reduced from 124 to 112. • At this time, treatment with metformin is not necessary. • Elevated Transaminases – New. • ALT and AST are high at 165 and 144. • Will monitor and add hepatitis panel and work up for other etiologies.

  15. CIMT Results • CIMT Results: • Normal. • R CCA: 0.633 mm; 50-75% • L CCA: 0.591 mm; 50-75% • No plaque present

  16. Follow Up Labs on Gemfibrozil and Lovaza 4

  17. NMR LipoProfile Insert NMR Lipoprofile 060611 JR59 Insert Page 1 Insert NMR Lipoprofile 060611 JR59 Insert Page 2

  18. Clinical Pearls

  19. Case Summary

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