1	Case Study #1 Postmenopausal, sedentary lifestyle Brother – past angioplasty at age 52 ‘Social’ smoker and trying to quit Depression x 10 years (fluoxetine) Borderline hypertension - HCTZ 25mg
2	Case Scenario #1 HDL-C: 0.8 mmol/L TG: 4.2 mmol/L TC: HDL 6.6 mmol/l Creatinine 110mmol/L Waist circumference: 96 cm BMI: 28 kg/m2 BP: 140/70 mmHg FBG: 6.7 mmol/L TC: 5.3 mmol/L LDL-C: 3.9 mmol/L
3	Question #1 Based on Framingham, is the estimated risk factor for this patient: Low risk Moderate Risk High Risk Unknown
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5	Question #2 What do the new guidelines recommend the LDL-C target to be for high risk patients? 50 % LDL-reduction Target of < 2.0 mmol/L All of the Above None of the above
6	NEW 2006 Canadian Dyslipidemia Guidelines
7	Target Lipid Levels Primary target is to achieve LDL-C < 2.0 mmol/L For patients with established CAD, a reduction in LDL-C of at least 50% is required to prevent progression or elicit regression of atherosclerosis An LDL-C level of <2.5 mmol/L may be adequate for high risk patients (based on FRS) Without established diabetes or vascular disease , and for a small subset of patients with stable CAD who do not have diabetes or saphenous vein bypass grafts Secondary treatment target is achievement of a TC:HCL-C ratio < 4.0 mmol/L
8	Question # 3 What risk reduction approach would be ideal for this patient, in addition to lifestyle modification? Statin monotherapy Statin + additional lipid lowering agent Increase current HCTZ or add another agent, which one? Smoking cessation
9	Question # 4 What would you like to know about her lifestyle? What would you recommend? How can you help her?
10	Case Study # 2 Mr. AJ is a 48 year old health conscious university professor, with a positive family history of CAD. ASA 81 mg OD (only medication) Nonsmoker Runs 2 km/day Brother “dropped dead” on squash court at age 51 Father died after CABG age 49 (smoker, overweight)
11	Case Study # 2 TC: 5.9 Trig: 2.2 LDL 3.7 HDL: 0.95 TC/HDL: 5.9 FBG: 6.3 BP 134/81 BMI: 25.3 Waist Circ: 95 cm
12	Question #1 What is his 10 year risk of MI? Low risk Moderate risk High risk
13	Question #2 Does he have Metabolic Syndrome? Waist circumference > 102 cm (40 in) men Triglycerides _> 1.7 mmol/L HDL < 1.0 mmol/L men; HDL < 1.3 mmol/L women Blood pressure _> 135/85 Fasting glucose > 6.2-7 mmol/L
14	Question # 3 What treatment/ tests would be beneficial? Statin? Other medication? EST? AIC?
15	Question 4 What questions do you want to ask him about his lifestyle? What else do you want to know? What advise would you give him?
16	Case Study # 3 Ms DK is a 51 year old peri-menopausal single mother. Smoker Strong Family History of CAD (mother had MI age 55) Sedentary “Borderline” diabetes Labile hypertension Depression X 5 years Frequent hot flashes No medications
17	Case # 3 TC: 6.8 Triglycerides: 2.8 LDL: 4.5 HDL: 1.0 TC/HDL: 6.8 FBG: 6.8 Creatinine: 150 BMI: 31.3 BP: 140/90 Waist circumference: 90 cm
18	Question # 1 What is her 10 year risk for CAD? Low risk? Moderate risk? High risk?
19	Question # 2 Does she have Metabolic Syndrome? Waist circumference > 88 cm (35 in) women Triglycerides _> 1.7 mmol/L HDL < 1.0 mmol/L men; HDL < 1.3 mmol/L women Blood pressure _> 135/85 Fasting glucose > 6.2-7 mmol/L
20	Question # 3 What treatments would she benefit from? Statin? Fibrate? Hormone replacement therapy? Diabetic agent? Lifestyle changes?
21	Question #4 What else do you need to know about her? How can you help her?
22	Case # 4 Mr. TG is a 44 year old teacher on no medications No exercise ( gets too SOB) Family history of diabetes (no CAD) Drinks 4 beer per day, more on weekends Ex-smoker, quit 5 years ago
23	Case # 4 TC: 5.9 Triglcerides: > 18.4 LDL: can’t measure HDL: 0.7 TC/HDL: 8.4 FBG: 8.9 Creatinine: 90 BP: 150/90 Waist circumference: 110 cm
24	Question # 1 What is his 10 year risk of MI? Low risk? Moderate risk? High risk?
25	Question # 2 Does he have Metabolic Syndrome? Waist circumference > 102 cm (40 in) men Triglycerides _> 1.7 mmol/L HDL < 1.0 mmol/L men; HDL < 1.3 mmol/L women Blood pressure _> 135/85 Fasting glucose > 6.2-7 mmol/L
26	Question # 3 What therapies would he benefit from? Statin? Fibrate? Diabetes agent? Which one? Blood pressure medication? Which one? ASA?
27	Question # 4 What lifestyle changes would you address?