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Date Submitted: 07/05/2015 12:04 AM
CASE STUDY
A 53-YEAR-OLD WOMAN WITH HYPERCHOLESTEROLEMIA
—
James J. Maciejko, MD, PhD*
HISTORY
A 53-year-old woman was referred for evaluation and treatment of hypercholesterolemia. She
was taking atorvastatin, 40 mg daily, until 8 weeks
ago, at which time the drug was discontinued
because of drug-induced myositis. Her medical history included coronary artery bypass graft surgery
at age 50, as well as hysterectomy, oophorectomy,
and cholecystectomy. She had irritable bowel syndrome, which flared up occasionally. Her drug
regimen consisted of amlodipine, losartan potassium, aspirin, and estradiol. She was a nonsmoker,
reported consuming 3 to 4 alcoholic drinks per
week, and had a paternal family history of coronary heart disease (CHD).
PHYSICAL EXAMINATION AND LABORATORY RESULTS
Physical examination revealed the following:
height, 60 inches; weight, 150 lb; body mass index
(BMI), 25.1 kg/m2; blood pressure, 130/84 mm Hg;
and heart rate, 78/min. Laboratory evaluation
showed no evidence of statin-induced myopathy. A
fasting lipid profile revealed a total cholesterol level
of 324 mg/dL, low-density lipoprotein cholesterol
(LDL-C) level of 229 mg/dL, high-density lipopro-
*Director of Preventive Cardiology, St. Johns Hospital,
Detroit, Michigan.
Advanced Studies in Medicine
s
tein cholesterol (HDL-C) level of 64 mg/dL, and
triglyceride level of 154 mg/dL. The lipoprotein (a)
[Lp(a)] was 35 mg/dL. Additional laboratory tests
showed a homocysteine level of 10.3 µmol/L, fasting
blood glucose of 84 mg/dL, creatine phosphokinase
level of 146 U/L, aspartate aminotransferase level of
18 U/L, and alanine aminotransferase level of 20 U/L.
DIAGNOSIS AND TREATMENT
The most likely cause of this patient’s hypercholesterolemia was polygenic hypercholesterolemia; she also
had prior myositis resulting from statin therapy. The
patient was advised to follow the Mediterranean diet
and was instructed to keep her caloric intake at...