Hyperlipidemia
Hyperlipidemia
Introduction
Patients diagnosed with hyperlipidemia have inherited or developed elevated fat or lipid levels in their blood. The condition increases the patient’s risk of blood vessel disease leading to stroke as well as heart disease. Patient Lori is a 44-year-old Caucasian female and during her well-woman-exam voiced no medical complaints. Lori is a telephone operator for a busy law firm. Her Vital signs: BP 128/84; wt; 133 lbs; Ht 64 inches; eyes have yellow-orange raised lesions on eyelids; remainder of exam is unremarkable.
Literature Review
According to Rosenson (2015), Nelson (2012), Chanoine (2008), Jones et al (2013), Bays et al (2014), and Jacobson et al (2015) the current literature on hyperlipidemia. Hyperlipidemia advises the condition does not cause symptoms it nonetheless increases an individual’s risk for developing cardiovascular disease (CVD). This includes coronary artery disease affecting blood vessels specific to supplying blood to the heart, cerebrovascular disease affecting blood supplies to the brain, and peripheral vascular disease disrupting needed blood flows to the body’s arms and legs.
Increased levels of lipid fats in the blood affect cholesterol and triglyceride levels as well. Any of these conditions can develop into heart attacks, chest pains, and strokes as well as other medical issues. The high risk factor for developing these medical conditions due to the onset of hyperlipidemia treatment is a typical recommendation for those diagnosed with the condition (Rosenson, 2015).
Differential Diagnosis
Physical
The overt physical symptom apparent in Lori is the yellow-orange raised lesions on her eyelids. This is an indication of the condition known as xanthelasma caused by high levels of cholesterol under the skin. This is an indication of possible onset of cardiovascular disease (Rosenson, 2015).
Pathophysiological
The pathophysiology of hyperlipidemia consists of the cholesterol, the triglycerides, and the phosopholipids transported in the bloodstream existing as lipd and protein complexes called lipoproteins. The cholesterol in particular aligns to development of coronary heart disease (Rosenson, 2015).
Pharmacologic
According to the literature a number of studies establishes statins are the most prescribed medicine to treat the condition. The U.S. Food and Drug Administration approved six drugs categorized in this class. Results of the comparative data reveal each of these reduce lipid levels in varying degrees. Of the six medicines the rosuvastatin and atorvastatin reduce the most LDL levels according to the American Heart Association (AHA) (2016).
Trials continue directed at comparison studies of the efficacy of two or more of the statins’ lowering lipids and according to the current evidence no compelling rationale stands to reason for choosing one statin of the six over another in terms of the usual primary care of patient in a clinical setting. At the same time, such patients having the familial hyperlipidemia combination it is suggested they begin treatment using either the rosuvastatin or the atorvastatin. In addition, research reveals that in such cases as heterozygous in familial hyperlipidemis there is xanthomas that adds additional Additionally, it has been shown that the presence of xanthomas in heterozygous familial hyperlipidemia confers additional risk for patient developing CVD requiring input from a specialist (AHA, 2016).
Treatment/Intervention
The fact remains, hyperlipidemia is a manageable condition using treatment intervention for controlling the cholesterol and triglyceride by lowering their levels. Other than the normal amounts of cholesterol the human body uses daily, either diet or genetics is the cause of increased levels in people. The overall health status considers the risks at hand and frame treatment intervention. A combination of choosing healthy diet intake and increasing and maintaining regular exercise are fundamental to lowering high cholesterol levels indicated by hyperlipidemia. The treatment/intervention typically calls for prescribing medication when the diet and exercise are not lowering the cholesterol and triglyceride levels allying the risk for CVD. Medication alone rarely lowers the high levels so it is critical to use healthy diet, exercise, and medication in conjunction with one the other (AHA, 2016).
In choosing a healthy diet it is important to read food content listed on food label consuming only those with low cholesterol and saturated trans-fats. According to the AHA (2016) a healthy dietary intake limits saturated fats daily from 5 to 6 percent in calories while reducing the trans-fat calorie intake.
Limiting the intake of dairy made from whole milk as well as red meat consumption reduces saturated and trans-fat problems. Replacing milk with skim, low fat, or fat-free dairy is recommended. Limiting intake of fried foods by using healthy cooking oils such as vegetable oil is another recommendation. Increasing fiber intake in the diet helps reduce cholesterol levels as much as 10 percent. Losing 10 percent of the current weight reduces the risk of CVD and is a way to reverse hyperlipidemia. Losing weight by diet is critical but exercise is another factor (AHA, 2016).
On the initial examination Lori reported her diet consists of high-fat content meals including consumption of processed junk foods as well as regular consumption of cheese. PHM: Patient smokes 2 packs of cigarettes a day for the past 15 years and drinks 3 beers daily. Her past medical history is framed in significant hypertension. Medications: Hydrochlorothiazide 50 mg daily. Patient return to the clinic six months after this initial exam her total cholesterol is 252 - HDL 30 – and, LDL 170 and according to the Framingham Heart Study (National Heart, Lung, and Blood Institute, 2012), she is well in the risk for developing CVD.
Analysis/Discussion
Review of the patient’s examination and a comparison to the risk factors for developing CVD according to the literature, Lori is a prime candidate along with developing co-morbidities associated with the disease. She has a job that is stressful, where she has no exercise, and her diet, smoking, and alcohol consumption are mitigating factors as well. The fact she is on Hydrochlorothiazide treating her edema with causal factors including kidney, heart, and possible liver disease are critical concerns for the patient state of undiagnosed health.
Now six months after the initial exam show her cholesterol levels well beyond the borderline of 130 to 159 showing at 252 means the hyperlipidemia is advancing. Lori is at the suggested age for screening the at risk conditions for CVD (AHA, 2016). While Lori does not have a weight problem it is clear her inactivity and her age are problematic for this to happen if she continues with the current lifestyle of inactivity, poor diet, alcohol, and tobacco consumption.
Expected Outcomes
Applying the suggested intervention and treatment in the case of Lori means expecting lowering her cholesterol to a safe level. With the prescribed life style modification, drastic change to her current diet intake, and increased exercise the expected outcomes is for a complete change in Lori’s lifestyle affecting poor diet, no meaningful exercise, ideally stopping smoking, as well as cutting her alcohol intake again, ideally to a glass of wine daily (AHA, 2016).
The effective loss of weight that research reveals dramatically lowers cholesterol is also fraught with its own issues according to research, because within a year of losing the weight it is put back on with patients going back to their previous poor lifestyle habits. Given these realities of life style change expectations it is more pragmatic to have expected outcomes align to achieving lowering the lipid issue caused by hyperlipidemia with initiating prescribed medications from the onset of treatment and intervention. Achieving lifestyle changes typically reduces the need for medication with ongoing assessment of the condition.
Conclusions
The above established that patients in general diagnosed with hyperlipidemia have inherited or developed elevated fat or lipid levels in their blood as represented in this case study of Lori. Her poor diet and her unhealthy lifestyle frame the causal factors for her having contracted this condition. Her current medication for edema in conjunction with the diagnosis of this condition exacerbates the likelihood of her developing CVD. The increase of her cholesterol levels over a six-month period shows the condition is increasing and the diagnosis is for immediate intervention and treatment by prescribing either rosuvastatin or the atorvastatin as there is no guarantee Lori will opt to change her diet or her lifestyle by curbing her smoking, alcohol intake, or increasing her exercise for a healthier lifestyle. Educating the client to risks she is immediately facing as well as the long-term prognosis for her health and well-being linked to her current medical condition is imperative.
References
American Heart Association. (2016). Hyperlipidemia. Retrieved from
http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/Hyperlipidemia_UCM_434965_Article.jsp#.Vpy9PSorLIU
Bays, H. E., Jones, P. H., Brown, W. V., & Jacobson, T. A. (2014). National Lipid Association Annual Summary of Clinical Lipidology 2015. Journal of Clinical Lipidology. Vol. 8. 51-536. Retrieved from
http://nlaresourcecenter.lipidjournal.com/Content/PDFs/Summary-Revised.pdf
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and Results in Project ImPACT: Hyperlipidemia. Retrieved from
https://www.pharmacist.com/sites/default/files/files/Project%20ImPACT%20Hyperlipidemia.pdf
Chanoine, P. (2008). Hyperlipidemia, Eating Disorders, and Smoking Cessation. Curr Opin Pediatrics. 20(6). 734-739.
Jacobson, T. A., Ito, M. K., Maki, K C., Orringer, C.E., Bays, H. E., et al. (2015). National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia: Part 1—Full Report. Journal of Clinical Lipidology. Retrieved from
https://www.lipid.org/sites/default/files/PIIS1933287415000598.pdf
Jones, N. J., Robinson, J., & Lichtenstein, A. H. (2013). 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Retrieved from
http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a.full.pdf
National Heart, Lung, and Blood Institute. (2014). Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack (Framingham Heart Study). Retrieved from
http://cvdrisk.nhlbi.nih.gov/
