A 53 Year Old Woman with Hypercholesterolmia

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...