Case StudiesQuiz of the month – January 2022
Take our patient case study quiz specially curated for you by our Faculty Member, Prof. Christopher Cannon.
Mortensen MB, Tybjærg-Hansen A, Nordestgaard BG
Journal: JAMA Cardiol
First published: July 6, 2022 DOI: 10.1001/jamacardio.2022.1876
Case Study: David is a 63-year-old man with a 20-year history of hypercholesterolemia and 5-year history of prediabetes. When the hypercholesterolemia was diagnosed, his LDL-C was 256 mg/dL. Since then, he has been managed primarily with high-intensity statin treatment (rosuvastatin 40 mg/d), dietary modification (low saturated fat diet), and daily exercise. One year ago, cardiology workup identified evidence of ASCVD (see chart below). At the time, David’s LDL-C was 162 mg/dL on treatment with maximal dose rosuvastatin, so the cardiologist recommended adding ezetimibe 10 mg qd. After 6 months of treatment, David’s LDL-C fell to 134 mg/dL.
Medical History | Hypercholesterolemia, 20 years Prediabetes, 5 years |
Vitals | Heart rate: 72 bpm Blood pressure: 118/74 mmHg Respiration rate: 18 bpm Temp: 98.6 |
Physical examination | Heart: normal sinus rhythm Lungs: clear to auscultation Extremities: no edema Skin: unremarkable Joints: no tendon xanthomas BMI: 23.5 kg/m2 |
Investigations | Today: Random blood glucose: 103 mg/dL A1C: 5.8% [normal <5.7] eGFR: 77 mL/min/1.73m2 Lipid panel: – LDL-C 134 mg/dL – HDL-C 52 mg/dL – Triglycerides 68 mg/dL – Total cholesterol 176 mg/dL One year ago: CT angiogram: high coronary artery calcium, nonocclusive atherosclerosis |
Medications | Rosuvastatin 40 mg qd Ezetimibe 10 mg qd |
Based on his diagnosis of established ASCVD, the cardiologist identified an LDL-C goal <70 mg/dL and added a PCSK9 inhibitor.
It has been 6 months since he started the PCSK9 inhibitor. He returned to the clinic today for a checkup. Workup identifies LDL-C 47 mg/dL. David reports good adherence to therapy and no side effects of treatment with rosuvastatin 40 mg, ezetimibe 10 mg qd, and a PCSK9 inhibitor.