You are a Physician’s Assistant and you are set to meet with a patient to talk a
ID: 123750 • Letter: Y
Question
You are a Physician’s Assistant and you are set to meet with a patient to talk about his cholesterol panel. The patient, Mr. Brown, is a 56 year old male who leads a largely sedentary lifestyle. He has admitted, in a previous visit, that his favorite activity is sitting on the couch and eating snacks while watching sports. He has also expressed concerns that you would try to drastically change his lifestyle (which he does not want to do) if his tests came back high. The panel that came back on Mr. Brown contains the following results: Test Result Triglycerides 145 mg/dL Cholesterol 210 mg/dL HDL 33 mg/dL LDL 160 mg/dL • Report the results to Mr. Brown – be sure to tell him his exact numbers. • Interpret the results for Mr. Brown – are the results normal? Abnormal? What are the normal/abnormal ranges for each test? • What are triglycerides? • What is cholesterol? • What are LDL and HDL? • Where is cholesterol produced? • What are the causes of high cholesterol? • What are the treatments for reducing high cholesterol? • What are the side effects of medication for treating high cholesterol? • Do the benefits of lowering cholesterol outweigh the risks of taking medication? • What options exist for a person to try and reduce his/her cholesterol without taking medication? • How would you alleviate any fears Mr. Brown may have regarding his condition? • What recommendations would you make to Mr. Brown knowing his concerns? • What approach would you take to encourage him to make any necessary lifestyle changes?
Explanation / Answer
Mr. Brown can contain the following results:
Triglycerides 145 mg/dL
Cholesterol 210 mg/dL
HDL 33 mg/dL
LDL 160 mg/dL
Triglycerides: In the body most of the fats are stored in the triglycerides form. It is formed from the excessive fat from what we eat or fat made from carbohydrates. Mr. Brown tested cholesterol level was 210 mg/dL which is borderline high risk.
Cholesterol is a fat which present in almost all the living cells of the body. Cholesterol is synthesized by liver and also obtained from fatty foods. In the making of hormones, vitamin D and adipose tissue cholesterol plays an essential role. When the levels of cholesterol can present in excess portion then these extra cholesterol can deposited in blood vessels of heart and forms plaque. The growth of cholesterol plaques slowly blocks blood flow in the arteries. Worse, a cholesterol plaque can suddenly rupture. The sudden blood clot that forms over the rupture then causes a heart attack or stroke. The cholesterol levels in blood should be less than 200 mg/dL and triglyceride levels to be less than 150 mg/dL.
LDL cholesterol stands for low density lipoproteins. It is considered as bad cholesterol because it transports triglycerides from the liver to different parts of the body. High LDL levels cause atherosclerosis in blood vessels. LDL levels should be less than 130 mg/dL.
HDL cholesterol stands for high density lipoprotein. HDL cholesterol is considered as good cholesterol since it transports triglycerides back to the liver. The normal levels of HDL cholesterol in blood should be more than 60 mg/dL.
Therefore, Mr. Brown has high cholesterol and LDL levels in his blood. Further, HDL levels are low. So, there is a need to decrease his cholesterol and LDL levels. This can be achieved by changing his life style and medications.
Medication: Lipid lowering drugs like statins (also known as HMG CoA reductase inhibitors) can be used to lower cholesterol levels.
Ex: Atorvastatin , Fluvastatin , Lovastatin and Pravastatin
Life style changes:
Regular physical activity
Avoiding fast foods and trans fats
Avoiding alcoholic beverages
Intake of complex carbohydrates like fibers
Health education and counseling should be given to Mr. Brown explaining him about the ill effects of having high cholesterol and the ways and means to avoid it. He should be encouraged to engage himself in some sort of physical activity like walking, jogging, dancing etc.
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