Question of the Week # 399

399)  A 65 year old man with history of diabetes mellitus is evaluated in your office during a routine follow-up visit. He does not have any complaints. He uses Glyburide and Metformin for his diabetes and Atorvastatin 80mg/day and Omega-3 Fatty Acids  for his dyslipidemia. He is compliant with diet and exercise. His weight has been stable. He does not smoke or consume alcohol. His most recent HgbA1C was 6.0% and a fasting lipid panel a month ago showed Total cholesterol of 125 mg%, LDL-C 70mg%, Triglycerides 100mg% and HDL-C 35mg%. You discuss with him that his lipid panel meets the recommendations with regard to LDL cholesterol and Non-HDL cholesterol goals. However, he insists that he be treated for his low HDL-cholesterol. You offer adding Niacin but after he heard about it’s side effects he refuses it and seeks alternatives.  Which of the following is the most appropriate recommendation for him?

A) Change Atorvastatin to Rosuvastatin

B) Add Cholestyramine

C) No further therapy

D) Discontinue Omega-3 Fatty Acids

E) Increase Atorvastatin

7 Responses

  1. C

  2. I will go with
    C) No further therapy
    Statin only mildly raise HDL cholesterol.
    Cholestyramine does not increase HDL cholesterol.
    Omega 3 fatty acid increase HDL cholesterol.

  3. c???

  4. C

  5. C) No further therapy

  6. The answer to this question is “A”.

    Rosuvastatin preserves or increases the Coenzyme Q10 levels and therefore it increases the HDL levels, if the patient exercises regularly.

    If the patient is compliant with diet and exercise and he has been taking atorvastatin which has controlled his LDL and Triglycerides then it’s best to use a statin with an added property of treating the HDL levels as well. Initially drug companies concentrated on targeting the lipid cholesterol but these days the studies are profound on targeting the lipid particle, be it HDL-C, LDL-C or triglycerides as a whole!

    I would tell you a trick or two for the exam. If the physician has offered a drug to the patient for instance in this case “niacin” and the patient refuses then it is best to switch to another drug which is beneficial. No further therapy will never be the right answer!

  7. Dr.Red—what is u r explanation?

    thx!

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