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75 Year Old Female With Familial Combined Hyperlipidemia and Diabetes

75 Year Old Female With Familial Combined Hyperlipidemia and Diabetes. Case Categories Primary Prevention Secondary Prevention Pediatric Case Familial Hypertriglyceridemia Diabetes Metabolic Syndrome Low HDL Familial Combined Hyperlipidemia Familial Hypercholesterolemia

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75 Year Old Female With Familial Combined Hyperlipidemia and Diabetes

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  1. 75 Year Old Female With Familial Combined Hyperlipidemia and Diabetes 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 Combined Hyperlipidemia, Diabetes, Statin Intolerance History of present illness: 75 year old female with familial combined hyperlipidemia and controlled diabetes. Recently stopped Crestor 10 and metformin 1500, as evidenced by lipid profile, due to tolerance issues. Here today for follow-up and treatment recommendations.

  2. Patient Information

  3. Patient History

  4. Current Medications

  5. Lipid Profile on Gemfibrozil 600 BID and Lovaza 4 / Off Crestor 10 and Metformin 1500 Fasting: NT = Not Tested

  6. Other Labs Worth Noting on Gemfibrozil 600 BID and Lovaza 4 / Off Crestor 10 and Metformin 1500 Fasting: NT = Not Tested

  7. Labs on Gemfibrozil 600 BID and Lovaza 4 / Off Crestor 10 and Metformin 1500

  8. NMR LipoProfile Insert NMR LipoProfile

  9. NMR Interpretation

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

  11. Initial Treatment & Management Continue Crestor 10 mg/day as tolerated and Gemfibrozil 600 mg BID for familial combined hyperlipidemia. Continue Lovaza 4 g/day for lipid and anticlotting benefits. Continue CO Q 10 800 mg/day for muscle aching. Start Cycloset 0.8 mg/day and gradually increase to 2-6/day for diabetes. Continue taking Synthroid 75 mcg/day for hyperthyroidism. Restart vitamin D3 1000 IU/day for vitamin D deficiency.

  12. Discussion (1 of 6) Risk Factors: Hyperlipidemia, Heart Disease, Metabolic Syndrome, Hypercoagulable State Assessment: Familial Combined Hyperlipidemia

  13. Discussion (2 of 6) Assessment: Hypertension

  14. Discussion (3 of 6) Assessment: Diabetes Type II

  15. Discussion (4 of 6) Assessment: Hypothyroidism

  16. Discussion (5 of 6) Assessment: Vitamin D Deficiency

  17. Discussion (6 of 6) Assessment: Vitamin B12 Deficiency

  18. 2 Month Follow Up on Gemfibrozil 600 BID, Crestor 10, Lovaza 4 and Cycloset 0.8 (1 of 3) • Familial Combined Hyperlipidemia – Improved. • Currently taking Crestor 10 mg and tolerating. Also taking Gemfibrozil 600 BID and Lovaza 4 g/day. • LDL-P lowered from 1881 to 712. Small LDL-P decreased from 1116 to 379. Total cholesterol lowered from 197 to 129. LDL-C reduced to 50 from 127. Triglycerides remained the same at 133. HDL increased from 43 to 52. • Continue therapy. • Hypertension – Deteriorated. • Blood pressure is 158/60. • Recommend monitoring blood pressure using home meter.

  19. 2 Month Follow Up on Gemfibrozil 600 BID, Crestor 10, Lovaza 4 and Cycloset 0.8 (2 of 3) • Diabetes Type II – Improved. • Added Cycloset 0.8, but stopped due to high cost. Recommend restarting with samples and researching rebates. • IR Score on NMR improved significantly and lowered from 48 to 31. HbA1c not checked this visit. • Sulfonylurea is not an option as patient has experienced dangerous side effects and potential heart risk, as well as hypoglycemia. Metformin is not an option due to intolerance. Actos is not an option due to cardiac issues and renal disease. Has not tried Byetta or Victoza, which can both be used with renal disease. Both medications also help lower blood pressure. Cycloset is the best option.

  20. 2 Month Follow Up on Gemfibrozil 600 BID, Crestor 10, Lovaza 4 and Cycloset 0.8 (3 of 3) • Hypothyroidism – Improved. • Currently taking Synthroid 75 mcg/day. • TSH remains stable at 0.87. • Vitamin D Deficiency – Unchanged. • Currently taking vitamin D3 1000 IU/day. • Levels remain about the same at 46. • Continue supplements. • Vitamin B12 Deficiency – Deteriorated. • Currently not taking B12 supplements. Levels are low at 353. • Start sublingal tablets 500 mcg/day and eat more foods high in vitamin B12.

  21. 2 Month Follow Up Labs on Gemfibrozil 600 BID, Crestor 10, Lovaza 4 and Cycloset 0.8 (1 of x)

  22. NMR LipoProfile Insert NMR LipoProfile

  23. Clinical Pearls

  24. Case Summary

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