Fasting lipid profile results for a 48-year-old male with diabetes are as follows: total cholesterol: 298 mg/dL,HDL cholesterol: 26 mg/dL,and triglycerides: 320 mg/dL.The patient has no evidence of coronary artery disease (CAD).What is the recommended course of action?

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For patients without clinical evidence of coronary or other atherosclerotic vascular disease,the National Cholesterol Education Program (NCEP)recommends health screening,including measurement of total cholesterol (TC)and HDL cholesterol,at least once every 5 years. Further evaluation is performed for those patients with a high TC,low HDL cholesterol (<35 mg/dL),or borderline TC who have at least two CAD risk factors (age >45 for men,age >55 for women or postmenopausal state without estrogen replacement,high blood pressure,smoking,diabetes,HDL <35 mg/dL,or family history of CAD before age 55 in male first-degree relative or before age 65 in female first-degree relative). The NCEP recommends that treatment decisions be based on the calculated level of LDL.For patients with an elevated LDL (³160 mg/dL)who have fewer than two risk factors in addition to elevated LDL and who do not have clinical evidence of atherosclerotic disease,the goal of treatment is an LDL level less than 160 mg/dL.For those who have at least two other risk factors,the goal of treatment is an LDL level less than 130 mg/dL.When LDL levels remain higher than 160 mg/dL despite dietary measures,and the patient has two or more risk factors (in addition to high LDL),or when LDL levels remain higher than 190 mg/dL even without added risk factors,the addition of drug treatment should be considered. For those with CAD,peripheral vascular disease,or cerebrovascular disease,the goal of treatment is an LDL less than 100 mg/dL. All patients with clinical evidence of coronary or other atherosclerotic disease should be evaluated with a fasting blood sample for measurement of TC,triglyceride,and HDL.LDL is calculated.

Fasting Lipid Profile Results for a 48-Year-Old Male with Diabetes