Patel Janhavi, Sharma Tanmya, Allan Connor, Curnew Gregory
Michael G. DeGroote School of Medicine, ON, Canada.
Faculty of Health Sciences, ON, Canada.
J Lifestyle Med. 2021 Jan 31;11(1):43-46. doi: 10.15280/jlm.2021.11.1.43.
In this report, we describe a case of a 37-year old man who presented with a history of total cholesterol > 14 mmol/L and triglyceride levels > 40 mmol/L. The patient was initially thought to have familial hypercholesterolemia due to his elevated total cholesterol, by his family physician. He was prescribed evolucumab, a proprotein convertase subtilisin/ kexin type 9 inhibitor drug which has shown efficacy for lowering low-density lipoprotein-cholesterol levels, to reduce his high total cholesterol. However, in this patient, the elevated total cholesterol was likely due to hypertriglyceridemia, rather than increased low-density lipoprotein-cholesterol levels. Through this case we provide an approach for the clinical management of patients with elevated total cholesterol with underlying triglycerides ≥ 10 mmol/L. The primary intervention for management of triglycerides ≥ 10 mmol/L involves lifestyle modifications including, changes in diet, exercise, reduction in body mass index, and abstinence from alcohol consumption. Secondary intervention involves management through pharmacotherapy with fibrates and statins. Creating a plan of action with the patient, incorporating lifestyle modifications alone, the patient was able to reduce the triglycerides from an average of 44.94 mmol/L to 3.28 mmol/L.
在本报告中，我们描述了一例37岁男性患者，其总胆固醇>14 mmol/L，甘油三酯水平>40 mmol/L。患者最初被其家庭医生认为因总胆固醇升高而患有家族性高胆固醇血症。他被处方了依洛尤单抗，一种前蛋白转化酶枯草杆菌蛋白酶/kexin 9型抑制剂药物，该药物已显示出降低低密度脂蛋白胆固醇水平的功效，以降低其高总胆固醇。然而，在该患者中，总胆固醇升高可能是由于高甘油三酯血症，而非低密度脂蛋白胆固醇水平升高。通过该病例，我们提供了一种针对总胆固醇升高且基础甘油三酯≥10 mmol/L患者的临床管理方法。对于甘油三酯≥10 mmol/L的管理，主要干预措施包括生活方式改变，如饮食调整、运动、降低体重指数以及戒酒。次要干预措施包括使用贝特类药物和他汀类药物进行药物治疗。与患者制定一个仅纳入生活方式改变的行动计划后，患者能够将甘油三酯水平从平均44.94 mmol/L降至3.28 mmol/L。
