QBank Cholesterol Screening question

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cubsfan

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So this is REALLY bugging--after getting this question wrong and looking it up, still unsure.

Summary:
58yo overweight white woman with h/o HTN, osteoporosis, GERD, and smoking (quit 3yrs ago). Her cholesterol is 220 (w/ LDL 155 and HDL 42). She comes in with no complaints and physical exam reveals nothing abnormal.

What is the intial therapy?
A. nothing
B. lifestyle changes
C. statin
D. Gemfibrozil
E. Niacin

The QBank response is: She has 4 risk factos (age, weight, smoke, h/o htn). Since her LDL is <160, try Lifestyle Modications first before a Statin or Niacin.

MY RESPONSE:
It was my impression that if a patient has >2 risk factors and the LDL is >130, then its time for pharm. Am I wrong on this? If so, then there is a discrepancy with some texts...

Would appreciate any thoughts...

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You are correct

No risk factors: Lifestyle changes (LC) if LDL > 160, meds if > 190
1-2 risk factors: LC if > 130, meds if > 160
>2 risk factors OR diabetes/CAD equivalent (eg, stroke, PVD, AAA, etc.): LC if > 100, meds if > 130

Risk factors
Age: male > 45, female > 55
Fhx: male with CAD < 55, female < 65
smoking
HTN
HDL < 40 (? check on this) but subtract one risk factor if HDL > 60
Diabetes

Obesity is NOT a risk factor in guiding treatment


cubsfan said:
So this is REALLY bugging--after getting this question wrong and looking it up, still unsure.

Summary:
58yo overweight white woman with h/o HTN, osteoporosis, GERD, and smoking (quit 3yrs ago). Her cholesterol is 220 (w/ LDL 155 and HDL 42). She comes in with no complaints and physical exam reveals nothing abnormal.

What is the intial therapy?
A. nothing
B. lifestyle changes
C. statin
D. Gemfibrozil
E. Niacin

The QBank response is: She has 4 risk factos (age, weight, smoke, h/o htn). Since her LDL is <160, try Lifestyle Modications first before a Statin or Niacin.

MY RESPONSE:
It was my impression that if a patient has >2 risk factors and the LDL is >130, then its time for pharm. Am I wrong on this? If so, then there is a discrepancy with some texts...

Would appreciate any thoughts...
 
I just looked this up in Crush Step 2 to see what it said there. It agrees with Kaplan. Crush says that with 2 or more CHD risk factors, try diet modifications if the LDL is <160, and meds if above.

I'm guessing this means that at some point Kaplan and Crush were correct, but the guidelines were revised. What are we supposed to do in this situation? If we answer using the new guidelines we get the question wrong. How often is step 2 updated?
 
cubsfan said:
So this is REALLY bugging--after getting this question wrong and looking it up, still unsure.

Summary:
58yo overweight white woman with h/o HTN, osteoporosis, GERD, and smoking (quit 3yrs ago). Her cholesterol is 220 (w/ LDL 155 and HDL 42). She comes in with no complaints and physical exam reveals nothing abnormal.

What is the intial therapy?
A. nothing
B. lifestyle changes
C. statin
D. Gemfibrozil
E. Niacin

The QBank response is: She has 4 risk factos (age, weight, smoke, h/o htn). Since her LDL is <160, try Lifestyle Modications first before a Statin or Niacin.

MY RESPONSE:
It was my impression that if a patient has >2 risk factors and the LDL is >130, then its time for pharm. Am I wrong on this? If so, then there is a discrepancy with some texts...

Would appreciate any thoughts...


Think cheap...lifestyle changes are the first step in management NO MATTER HOW MANY RISK FACTORS.
 
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Lifestyle modification can lower cholesterol at least 15%.
My cholesterol went from 221 to 185 by eating very minimal to minimal meat.
I definitely go with lifestyle modification!
Also Pox is right think cheap! And in general you want to be conservative, but not passive.
 
Pox in a box said:
Think cheap...lifestyle changes are the first step in management NO MATTER HOW MANY RISK FACTORS.


Boo, bad advice. Cholesterol of 350 walks in to your office, you better not send him out with 'lifestyle change' as a prescription and no statin.
 
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