Lipid Profile and risk of future coronary events - USMLE Forums
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Old 10-19-2011
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Heart Lipid Profile and risk of future coronary events

A 58-year-old man comes to the clinic for a followup visit. He was discharged recently from the hospital after suffering a non-ST segment elevation myocardial infarction. In the hospital, he was started on empiric medications for dyslipidemia, in addition to being placed on a beta-blocker, aspirin, and clopidogrel. Although he has many questions about his diagnosis of coronary heart disease, he is particularly concerned about his lipid status. A quick review of his fasting lipid panel reveals that, before starting medical therapy, he has elevated cholesterol, triglycerides, and LDL cholesterol levels, and a low HDL cholesterol level. Regarding this patientís lipid profile, his greatest risk for future coronary events correlates most strongly with which of the following?
A. Elevated total cholesterol level
B. High triglyceride levels
C. Increased LDL cholesterol levels
D. Low HDL cholesterol levels
E. Ratio of HDL to LDL cholesterol
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Old 10-19-2011
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C. Increased LDL cholesterol levels ?
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Old 10-19-2011
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C increased LDL..

Just a quick question..what is the source of ur questions?? i hope not the U world coz that way u r not being fair to us!!!
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Old 10-19-2011
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Quote:
Originally Posted by kundra View Post
C increased LDL..

Just a quick question..what is the source of ur questions?? i hope not the U world coz that way u r not being fair to us!!!
No... It's not UW. Don't worry.
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Old 10-19-2011
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I i initially got scared myself as i had finished uworld and was thinking god help me i dont remember any questions like these....
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Old 10-20-2011
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i think its HDL/LDL ratio..
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Old 10-20-2011
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i guess C increased LDL
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C. Increased LDL cholesterol levels
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I'm Predictable In The Unpredictable Future !
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Default Answer

The correct answer is C. The cholesterol subset that correlates most strongly with coronary events is LDL cholesterol levels. When multiple lipid abnormalities exist, the goal of treatment generally should focus first on meeting LDL goals. If there are significant other abnormalities after the LDL target has been reached, it may be appropriate to switch to a medication that also has a beneficial effect on those levels. For this patient, his LDL goal is less than 100 mg/dL, as he has documented coronary artery disease.

Although there is a definite correlation between total cholesterol (choice A) and coronary risk, the LDL cholesterol subset is more predictive of future cardiac events. Current treatment guidelines are based on LDL cholesterol, risk for (or presence of) coronary heart disease, and a handful of cardiac risk factors, such as family history and tobacco use.

Triglyceride levels (choice B) are not as predictive of future coronary events as LDL cholesterol levels. Patients with very high triglyceride levels or elevated triglycerides with other risk factors for coronary disease often are treated with a triglyceride-lowering agent, such as nicotinic acid or gemfibrozil.

Low HDL levels (choice D) are a cardiac risk factor. LDL cholesterol levels, however, are more predictive of future events. Current guidelines are to first treat LDL cholesterol. If HDL remains low after measures to bring LDL cholesterol to target are initiated, then HDL becomes an appropriate second goal.

The ratio of HDL to LDL (choice E) is not used commonly. To account for this intuitive relationship between the independent effects of LDL and HDL cholesterol, the total-to-HDL cholesterol ratio has been suggested. Although there is evidence suggesting this may be more predictive than looking at an isolated LDL level, cholesterol-lowering trials are still based on LDL measurements.
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