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Q: What other changes, if any, do you make in WM’s treatment plan?
A: Although statin treatment has lowered WM’s LDL-C, it is still above the recommended target value of 100 mg/dL.2,3 ATP-III cholesterol guidelines target LDL-C as the primary treatment target; therefore, WM’s treatment should be intensified in order to reach this LDL-C treatment goal. This could be accomplished by increasing the dose of the statin, by changing to a more potent statin, or by adding another lipid-lowering agent.
One consideration in making the decision of how to alter his pharmacotherapy is that WM’s triglycerides are >200 mg/dL and his HDL-C is low. According to ATP-III treatment guidelines, the secondary treatment target for patients with this lipid pattern is non-HDL-C (calculated by subtracting HDL-C from total cholesterol; target: <130 mg/dL). Because low HDL-C is an independent risk factor for cardiovascular events, interventions to increase HDL-C would be desirable.
If the goal of a total HDL of above 40 mg/dL has not been reached with the addition of the TZD, combination lipid-lowering therapy may be necessary in order for this patient to reach treatment goals (Table 3).2,3,9,10
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