What is the diagnosis for a 27-year-old male with elevated LDL (Low-Density Lipoprotein) and total cholesterol levels?

Diagnosis: Dyslipidemia (Elevated LDL-C and Total Cholesterol)

This 27-year-old male has dyslipidemia with LDL-C of 140 mg/dL and total cholesterol of 244 mg/dL, which requires immediate lifestyle intervention and consideration for familial hypercholesterolemia screening given his young age and significantly elevated lipid levels. 1

Risk Stratification and Diagnostic Considerations

Cardiovascular Risk Assessment

• With 0-1 coronary heart disease (CHD) risk factors, this patient's LDL-C goal is <160 mg/dL, which he currently does not meet 1
• His LDL-C of 140 mg/dL falls in the range where diet, weight management, and physical activity are the primary interventions 1
• Drug therapy would be recommended if LDL-C remains ≥190 mg/dL, or is optional for LDL-C 160-189 mg/dL 1

Screen for Familial Hypercholesterolemia (FH)

• At age 27 with LDL-C of 140 mg/dL and total cholesterol of 244 mg/dL, familial hypercholesterolemia should be strongly considered 2
• FH is characterized by significantly elevated LDL-C levels and early-onset coronary artery disease, with heterozygous FH requiring baseline LDL-C ≥160 mg/dL or positive family history 3, 2
• Obtain detailed family history of premature cardiovascular disease (CHD in male first-degree relative <55 years or female first-degree relative <65 years) 1
• If FH is suspected, genetic testing for LDLR gene mutations should be considered 2

Additional Risk Factor Assessment

• Screen for other CHD risk factors: cigarette smoking, hypertension, HDL-C <40 mg/dL, family history of premature CHD, or age ≥45 years for men 1
• Obtain complete fasting lipid profile including HDL-C and triglycerides to assess for mixed dyslipidemia 1
• Screen for secondary causes: diabetes, thyroid dysfunction, kidney disease, medications 4

Initial Management Algorithm

First-Line: Intensive Lifestyle Modification

• Implement Mediterranean or DASH eating pattern with reduction of saturated fat, elimination of trans fats, increased unsaturated fats, and increased viscous fiber and plant stanols/sterols 4
• Prescribe at least 150 minutes of moderate-intensity exercise per week 4
• Target 5-10% weight loss if overweight, eliminate added sugars, restrict saturated fat 5
• Complete smoking cessation if applicable 1

Monitoring Strategy

• Reassess fasting lipid panel after 4-6 months of lifestyle interventions 4
• If LDL-C remains ≥160 mg/dL after 3-6 months of diet therapy, drug therapy becomes optional 1
• If LDL-C reaches ≥190 mg/dL, drug therapy is recommended regardless of other risk factors 1

Pharmacotherapy Considerations

• Statin therapy is generally not first-line for this patient unless additional ASCVD risk factors are present or LDL-C exceeds thresholds after lifestyle modification 4
• For patients aged 20-39 years with additional atherosclerotic cardiovascular disease risk factors, statin therapy may be reasonable in addition to lifestyle therapy 4
• If statin therapy is initiated, atorvastatin 10-20 mg daily would provide 36-43% LDL-C reduction 3

Expected Outcomes and Follow-up

Lifestyle Modification Alone

• Expect 10-15% LDL-C reduction with intensive dietary changes 4
• Target LDL-C <160 mg/dL for this risk category 1
• Therapeutic response typically seen within 2-4 weeks and maintained during chronic therapy 3

If Statin Therapy Required

• Atorvastatin 10 mg would reduce LDL-C by approximately 36%, bringing his LDL-C from 140 mg/dL to approximately 90 mg/dL 3
• Monitor AST/ALT and creatine kinase at baseline before starting statin 5
• Reassess lipid panel 4-6 weeks after initiating therapy 5

Critical Pitfalls to Avoid

• Do not overlook familial hypercholesterolemia in a 27-year-old with these lipid levels—failure to diagnose FH leads to inadequate long-term management and premature cardiovascular disease 2
• Do not initiate pharmacotherapy before giving adequate trial (4-6 months) of lifestyle modifications in young adults without additional risk factors 4
• Do not focus exclusively on LDL-C without obtaining complete lipid profile including HDL-C and triglycerides 1
• Do not ignore family history—premature cardiovascular disease in first-degree relatives significantly increases this patient's lifetime risk 1, 4
• Do not assume low short-term risk means no intervention needed—elevated LDL-C at age 27 represents decades of cumulative atherosclerotic burden 6