From the Guidelines
The plan of care for this patient should focus on addressing her elevated triglycerides (323) and low HDL (36), while continuing management of her asthma, and I recommend starting atorvastatin 20mg daily to improve her lipid profile, as supported by the most recent and highest quality study 1.
Key Considerations
- The patient's elevated triglycerides and low HDL levels indicate significant dyslipidemia, increasing her cardiovascular risk.
- According to the 2015 study 1, lifestyle modification focusing on the reduction of saturated fat, trans fat, and cholesterol intake, increase of omega-3 fatty acids, viscous fiber, and plant stanols/sterols, weight loss (if indicated), and increased physical activity should be recommended to improve the lipid profile.
- The same study 1 suggests that for patients with diabetes aged <40 years with additional CVD risk factors, consider using moderate- or high-intensity statin and lifestyle therapy, which can be applied to this patient's case given her age and lipid profile.
Recommendations
- Start atorvastatin 20mg daily to improve her lipid profile, as statin therapy is recommended for patients with significant dyslipidemia 1.
- Counsel the patient on lifestyle modifications including a low-fat diet, reduced simple carbohydrate intake, increased physical activity (aim for 150 minutes of moderate exercise weekly), and weight management if applicable.
- Limit alcohol consumption and increase intake of omega-3 fatty acids through fish or supplements.
- Continue her current medications for asthma and hypertension (Losartan 50mg daily, albuterol nebulizer and inhaler as needed, cetirizine 10mg daily, and montelukast 10mg daily).
- Schedule a follow-up appointment in 3 months to reassess lipid levels and medication effectiveness.
Rationale
- The combination of lifestyle changes and pharmacological intervention provides the most effective approach to improving her lipid profile while maintaining control of her existing conditions, as supported by the 2011 study 1.
- Statin therapy is recommended because her triglyceride level exceeds 300 mg/dL, indicating significant dyslipidemia that increases cardiovascular risk, as stated in the 2011 study 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Plan of Care
The patient presents with elevated triglycerides and low HDL, indicating dyslipidemia. The plan of care should focus on lifestyle modifications and potential pharmacological interventions.
- Lifestyle Modifications:
- Dietary changes: Replace saturated fat with MUFA or n-6 PUFA to lower plasma LDL cholesterol and ameliorate the LDL/HDL ratio 2.
- Increase consumption of fiber-rich, low GI foods to lower LDL cholesterol without detrimental effects on triglycerides 2.
- Consider the traditional Mediterranean way of life as a useful model for lifestyle modifications 2.
- Promote patient-centered care to increase knowledge on the risks and prevention of CHD, identify barriers to lifestyle modifications, and develop individualized plans for healthy living 3.
- Pharmacological Interventions:
- Consider combination therapy with statins and omega-3 fatty acids, which has been shown to be more effective in reducing total cholesterol/HDL cholesterol than statin monotherapy 4.
- Omega-3 fatty acids have been found to significantly reduce fasting and postprandial serum triglyceride concentrations 5.
- Fibric acid derivatives may also be considered for therapeutic intervention to reduce triglyceride concentrations 5.
- Monitoring and Follow-up:
- Regularly monitor lipid panels, blood pressure, and body mass index to assess the effectiveness of lifestyle modifications and pharmacological interventions.
- Adjust the plan of care as needed based on the patient's response to treatment and any changes in their medical condition.
- The importance of alcohol intake, weight reduction, and physical activity should also be discussed with the patient 2, 6.