What is the significance of elevated Total Cholesterol (260 mg/dL), Triglycerides (128 mg/dL), Low High-Density Lipoprotein (HDL) Cholesterol (37 mg/dL), and High Low-Density Lipoprotein (LDL) Cholesterol (199 mg/dL) in a patient's lipid profile?

From the Guidelines

You have high cholesterol levels that require immediate attention, and I strongly recommend starting a statin medication, such as atorvastatin 20-40mg daily or rosuvastatin 10-20mg daily, along with lifestyle modifications to reduce your cardiovascular risk. Your total cholesterol is 260 mg/dL (high), LDL cholesterol is 199 mg/dL (high), and HDL cholesterol is 37 mg/dL (low), while your triglycerides are within normal range at 128 mg/dL. Your cholesterol ratios (Total Cholesterol/HDL and LDL/HDL) are elevated, indicating increased cardiovascular risk, as supported by the 2016 ESC/EAS guidelines for the management of dyslipidaemias 1. The comment about evaluating for Familial Hypercholesterolemia suggests your doctor may want to investigate if your high cholesterol has a genetic component, as recommended by the European Society of Cardiology guidelines 1. Lifestyle modifications, including a Mediterranean or DASH diet low in saturated fats, regular exercise (150 minutes of moderate activity weekly), weight management if needed, and avoiding tobacco, are also crucial in improving your overall lipid profile, as suggested by the 2019 standards of medical care in diabetes 1. Statins work by inhibiting cholesterol production in your liver, and their use is recommended as the primary treatment to reach the LDL-C goal, with a target of < 1.8 mmol/L (70 mg/dL) or a reduction of at least 50% if the baseline LDL-C is between 1.8 and 3.5 mmol/L (70 and 135 mg/dL) for patients at VERY HIGH CV risk, as stated in the 2016 ESC/EAS guidelines 1. Follow up with your healthcare provider in 6-12 weeks after starting treatment to reassess your lipid levels and adjust medication if necessary, as recommended by the 2019 standards of medical care in diabetes 1. Some key points to consider:

• The benefits of statin therapy in reducing cardiovascular risk, as demonstrated by numerous studies, including a meta-analysis of 170,000 participants 1
• The importance of lifestyle modifications in improving lipid profiles, as reported by Pedersen and Saltin 1 and Aadahl et al. 1
• The need for regular monitoring of lipid levels and adjustment of treatment as necessary, as recommended by the 2019 standards of medical care in diabetes 1

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Lipid Profile Results

The provided lipid profile results indicate:

• Total Cholesterol: 260 mg/dL (High)
• Triglycerides: 128 mg/dL (Within normal range)
• HDL Cholesterol: 37 mg/dL (Low)
• LDL Cholesterol: 199 mg/dL (High)
• T. Chol/HDL Ratio: 7.0 (High)
• LDL/HDL Ratio: 5.4 (High)

Familial Hypercholesterolemia (FH)

The comment suggests considering evaluating for Familial Hypercholesterolemia (FH) if clinically indicated. According to 2, FH is a genetic disorder characterized by elevated LDL-cholesterol levels and early onset of atherosclerotic cardiovascular disease. The study highlights the importance of identifying individuals with FH and managing their lipid levels to reduce cardiovascular risk.

Lipid Management

The results indicate that the individual's lipid levels are not within the recommended range. According to 3, current treatment goals for FH recommend LDL-C ≤2.5 mmol/L (∼100 mg/dL) or ≤1.8 mmol/L (∼70 mg/dL) in very high-risk subjects. The study suggests that achieving these goals can be challenging, and new treatment modalities may be needed.

Treatment Options

Several treatment options are available to manage lipid levels, including:

• Statins: According to 4, statins are first-line therapy for lowering LDL cholesterol in FH, particularly in heterozygous patients.
• Ezetimibe: Combination of statins with ezetimibe and PCSK9 inhibitors can significantly improve the efficacy of treatment 4.
• PCSK9 inhibitors: These inhibitors may fulfill an important unmet need for very high-risk patients who are not able to achieve LDL-C goals with conventional agents 5.

Life Course Approach

A life course approach to managing FH is recommended, emphasizing treatment across the life course, from birth through childhood, adolescence, young adulthood, peripregnancy, middle age, and late in life 6. This approach recognizes the importance of family experiences and improving adherence to treatment.