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  #1  
Old 10-17-2011
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Question Diabetic and Hypertensive; Goal LDL level!

A 57-year-old woman comes to the clinic for a routine health check. She has no current complaints but wants her blood pressure and her blood glucose level checked. Over the past 10 years, she has struggled with diabetes and hypertension. She is assertive about preventive healthcare measures and has had recent normal ophthalmologic examinations and podiatry visits. In addition to checking her diabetes and hypertension and a urine microalbuminuria, you recommend a lipid panel as part of her healthcare maintenance examination. Her lipid panel reveals a cholesterol level of 225 mg/dL, an HDL cholesterol level of 38 mg/dL, and an LDL cholesterol level of 138 mg/dL. Which of the following is the goal LDL cholesterol level for this patient?

A. Depends on triglyceride levels
B. Less than 100 mg/dL
C. Less than 130 mg/dL
D. Less than 160 mg/dL
E. Less than 200 mg/dL
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Old 10-17-2011
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For all hyperlipidimic patients the target is less than 100mg/dl
but for patients with very high risk the goal is less than 70 mg/dl
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Old 10-17-2011
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regarding LDL managment

CAD= PAD=Aortic Disease=Carotid disease = DM

they are all equivalent risk factors ie severe risk

just to make sure im clear CAD = aoronary aretery disease , while P =peripheral

so

if CAD (or its equivalent) ldl goal is under 100

if multiple high risk CAD equvalents (as i stated above) LDL goal is under 70

If 1 risk factor ( not the severe risk ones) then goal is under 160
is 2 risk factor goal is 130
also as a rehash rish facotors are

HTN
Hyper lipidemia
Smoking
Family HX
Age
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Old 10-17-2011
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B. Less than 100 mg/dL
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Old 10-17-2011
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The correct answer is B. Diabetes is considered a coronary heart disease equivalent. In large trials, it has been shown to be a significant risk factor for coronary events, and thus warrants aggressive LDL cholesterol control. The goal is less than 100 mg/dL, and pharmacologic therapy is recommended if levels are greater than 130 mg/dL. As diabetes is a major cardiac risk factor, lipid level checks must be part of routine health care maintenance.
The evidence for serum triglycerides is not conflicting, as are recommendations for treatment in patients with diabetes. LDL cholesterol treatment goals, however, do not depend on triglyceride levels (choice A). LDL cholesterol is an independent risk factor for cardiac events.
Patients with two risk factors, which include hypertension, low HDL cholesterol, tobacco use, family history, and age, have a lower LDL cholesterol goal. These patients’ target LDL is less than 130 mg/dL (choice C).
For patients with no major risk factors for cardiac events, a goal of less than 160 mg/dL (choice D) is appropriate.
For any patient, a cholesterol level approaching 200 mg/dL (choice E) is too high.
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Old 11-19-2011
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Quote:
Originally Posted by docnas View Post
regarding LDL managment

CAD= PAD=Aortic Disease=Carotid disease = DM

they are all equivalent risk factors ie severe risk

just to make sure im clear CAD = aoronary aretery disease , while P =peripheral

so

if CAD (or its equivalent) ldl goal is under 100

if multiple high risk CAD equvalents (as i stated above) LDL goal is under 70

If 1 risk factor ( not the severe risk ones) then goal is under 160
is 2 risk factor goal is 130
also as a rehash rish facotors are

HTN
Hyper lipidemia
Smoking
Family HX
Age
NCEP ATP III
CHD and CHD risk equivalent (Diabetes, chronic kidney disease) <100
Multiple (2+) risk factors <130
0-1 risk factor <160

NCEP Report (ATP III Update 2004)
optional LDL <70 mg/dL for those who have had a recent acute coronary event or who have CVD combined with either diabetes or severe or poorly controlled risk factors.

In 2006, the American Heart Association (AHA) and American College of Cardiology (ACC) updated their secondary prevention guidelines for lipid management, echoing the recommendations made by the NCEP 2 years earlier but strengthening some of them as well. As with the NCEP guidelines, the LDL goal remains at <100 mg/dL, and <70 mg/dL has been added as an optional goal. The AHA/ACC update extends the <70 mg/dL option to all patients with coronary artery disease (CAD), not just to those at very high risk, a view that remains controversial.
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Old 11-19-2011
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yeah i tot the answer was <100 when i saw the title of the thread. i saw this on UW. UW also said tht with CAD risk then the safest is <70.
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Old 11-22-2011
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yep...<70.

Nov 2011...new update!

AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2011 Update : A Guideline From the American Heart Association and American College of
Cardiology Foundation

http://circ.ahajournals.org/content/...5eb4d.full.pdf

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Old 11-23-2011
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if pt have only DM then LDL goal is < 100
ut pt have cerebral vascular disease + DM (count as a high risk ) then < 70

This pt have DM so goal is <100.
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Old 11-23-2011
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Quote:
Originally Posted by usmlekzz View Post
if pt have only DM then LDL goal is < 100
ut pt have cerebral vascular disease + DM (count as a high risk ) then < 70

This pt have DM so goal is <100.
cerebral vascular disease?...nope
CVD = Cardiovascular Disease

<70 if:

Presence of established CVD plus
(1) multiple major risk factors (especially diabetes)
(2) severe and poorly controlled risk factors (especially continued cigarette
smoking)
(3) multiple risk factors of the metabolic syndrome (especially high triglycerides 200 mg/dL plus non–HDL-C 130 mg/dL with low HDL-C 40 mg/dL),
(4) patients with ACSs.
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