Question

1. Calculate and comment on the LDL cholesterol values. What does the presence of small dense LDL mean?
2. How many cardiovascular risk factors does this patient have?
3. Discuss the type of hyperlipidaemia this patient is likely to have.
4. What further tests and dietary/drug treatments would you recommend for this patient?

Sample A is from a 35 year old male who visited his GP complaining of chest pain during exercise. An ECG taken at rest was normal but ischaemic changes developed on exercise. A family history revealed that his father died of a heart attack at the age of 45 years. The laboratory test results for his fasting blood sample were as follows:

Analyte                       Patient values                                                Reference range for fasting

     blood sample

Sodium                                          139                                                135-145 mmol/L

Potassium                                      4.1                                                 3.0-5.0 mmol/L

Total protein                                                    69                                                  65-80 g/L

Albumin                                        35                                                  35-47 g/L

Calcium                                         9.3                                                 9.0-10.5 mg/dl

Lactate dehydrogenase                  250                                                90-190 IU/L

Creatine kinase                              129                                                30-60 IU/L

Asparatate transaminase               70                                                  < 40 IU/L

Gamma glutamyl transferase        30                                                  < 50 IU/L

Total Bilirubin                                                13                                                  0.4-15 μmol/L

Glucose                                         12                                                  3.5-5.5 mmol/L

Fructosamine                                                   351                                                205-285 μmol/L

Cholesterol                                                     

                  Total                                              7.2                                                 <5.2mmol/L

                  HDL                                              1.4                                                 >1.5 mmol/L

                  LDL                                              ?                                                    <3.5 mmol/L

Triglycerides                                                   2.95                                               <1.7mmol/L

On the gradient gel electrophoresis, plasma sample for this patient showed the presence of small dense LDL particle.

Answer 1

Question no 1)

Calculation of LDL cholesterol values

Total cholesterol= LDL+HDL+Triglycerides

As mentioned in the question HDL= 1.4mmol/ L

Total cholesterol= 7.2mmol/l

Triglycerides=2.95mmol/ l

As per formula LDL = TOTAL CHOLESTEROL- HDL+Triglycerides

Substituting values LDL = 7.2-(1.4+2.95)

=2.85mmol/ l

Presence of LDL means

The presence of smalls dense LDL cholesterol (sdLDL-c), is a distint LDL  cholesterol subclass, which is associated with raised TG and decreased HDL-c levels in adiposity and diabetes, playing a distinct metabolic role in atherosclerosis

Question no 2) cardiovascular Risk factors that he have

• Ischemia on exertions
• Family history of heart attack
• The total cholesterol level is elevated showing that there is high risk for developing cardiovascular disorders

Question no 3) the patient is having hyper triglycerimia

answered by: anonymous