One-third of the American population is considered to be at high-risk for cardiovascular disease. A prevalent obesity epidemic, uncontrolled hypertension, and metabolic syndromes, and consumption of unhealthy diets in conjunction with high stress and lack of regular exercise all contribute to the crisis. Cholesterol is also a major component. An increase of saturated fats and cholesterol in the diet leads to an increase in LDL levels in individuals. Atherosclerosis involves three major classes of lipoproteins: LDL, HDL, and VLDL (Woo & Robinson, 2015). RL’s fasting triglyceride is 150 mg/dL, which is right on the borderline of normal. Goal amount is to keep below 150. Most of the cholesterol in plasma is carried in LDLs or low-density lipoproteins. Therefore, levels below 100 mg/dL are optimal. In the case of RL, his LDL-C level is 160 mg/dL. HDLs perform reverse transport, by which cholesterol may be removed from the cells. Research links low levels of HDL to increased coronary morbidity and mortality, and low levels are shown to be a risk factor for CVD. However, newer research shows that an effort to increase this number does not provide as much benefit as once thought. In addition, higher HDL levels have no benefit if LDL is still high. According to the CDC (2020), desirable HDL level is greater than or equal to 60 mg/dL. RL’s level is 34 mg/dL, which is below desirable level.
Lifestyle modifications such as diet and exercise can affect cholesterol levels. That was initially recommended to RL without much change in his levels. This includes exercise of a least thirty minutes per day most days of the week, in addition to reduced intake of saturated fats, increased plant consumption, a cholesterol intake of less than 200 mg/day, increased soluble fiber intake, increased monosaturated fat intake, dietary fiber intake of 20 to 30 gm/day, and total calories to maintain weight (Woo & Robinson, 2015). RL has a BMI of 29, which is considered overweight in an adult by the CDC (2020). He also has past medical history of hypertension and MI, which are both risk factors of hyperlipidemia. Therefore, he would need to be started on a drug regimen for this condition due to the fact his cardiac risk is greater than 7%. Patients should be advised to check their BMI and cholesterol levels annually. If the patient is a smoker, smoking cessation education should take place immediately. Alcohol intake should be monitored. Dietary teaching and a nutrition consult may be necessary. Patients should be advised against high cholesterol diets such as Atkins. Supplements such as omega-3’s may be considered by the provider.
A low to moderate dosing of a statin would be the preferred therapy in this population due to the positive effects on total cholesterol levels (LDL goal less than 100) with relatively few side effects. Patient should be strongly encouraged to make aggressive lifestyle changes with dietary therapy. A baseline liver function should be checked along with CK and a lipid panel. The lipid panel should be rechecked at 6 to 8 weeks and after adjustments in dosage. This should be followed at 8 to 12-week intervals for one year. If there is no improvement after three months, the patient should have the dosage increased, be switched to a different agent, or be considered for combination drug therapy (Woo & Robinson, 2015). Myalgia is a commonly reported adverse effect of statins. In addition, there is some correlation to diabetes in this population. Therefore, A1C and monitoring for glycemic events should be considered in addition to blood pressure checks. Cholesterol control requires lifelong adherence to a regimen that is strongly based in therapeutic lifestyle changes. This should be emphasized to the patient. Adherence is crucial. In addition, myopathies (which have a familial component) and memory issues should be addressed at follow-up appointments. Rhabdomyolysis is another adverse effect of statin drugs (Woo & Robinson, 2015).
Woo, T. M., & Robinson, M. V. (2015). Pharmacotherapeutics for advanced practice nurse prescribers (4th ed.). Philadelphia, PA: F.A. Davis Company
CDC. (2020, January 31). Getting your cholesterol checked. Retrieved from: https://www.cdc.gov/cholesterol/cholesterol_screening.htm
CDC. (2020, April 10). Healthy weight: About adult BMI. Retrieved from: https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html
Sexton, S. (2017, January 15). U.S. Preventive Services Task Force. Statin use for the primary prevention of cardiovascular disease in adults: Recommendation Statement. American Family Physician. 95(2). Retrieved from: https://www.aafp.org/afp/2017/0115/od1.html