Question

Sample A is from a 35 year old male who visited his GP complaining of chest pain during exercise. An ECG taken at rest was normal but ischaemic changes developed on exercise. A family history revealed that his father died of a heart attack at the age of 45 years. The laboratory test results for his fasting blood sample were as follows:

Analyte                       Patient values                        Reference range for fasting

     blood sample

Sodium                                    139                              135-145 mmol/L

Potassium                                4.1                               3.0-5.0 mmol/L

Total protein                           69                                65-80 g/L

Albumin                                  35                                35-47 g/L

Calcium                                  9.3                               9.0-10.5 mg/dl

Lactate dehydrogenase           250                              90-190 IU/L

Creatine kinase                       129                              30-60 IU/L

Asparatate transaminase         70                                < 40 IU/L

Gamma glutamyl transferase 30                                < 50 IU/L

Total Bilirubin                        13                                0.4-15 μmol/L

Glucose                                   12                                3.5-5.5 mmol/L

Fructosamine                          351                              205-285 μmol/L

Cholesterol                             

            Total                            7.2                               <5.2mmol/L

            HDL                            1.4                               >1.5 mmol/L

            LDL                            ?                                  <3.5 mmol/L

Triglycerides                           2.95                             <1.7mmol/L

On the gradient gel electrophoresis, plasma sample for this patient showed the presence of small dense LDL particle.

1. Calculate and comment on the LDL cholesterol values. What does the presence of small dense LDL mean?
2. How many cardiovascular risk factors does this patient have?
3. Discuss the type of hyperlipidaemia this patient is likely to have.
4. What further tests and dietary/drug treatments would you recommend for this patient?

Answer 1

LDL levles are not reported in the table, however presence of small dense particles ar e a sign of arteriosclerosis, also the levels of HDL is low. HDL is considered to be good cholesterol and should be above 1,5 mmol/L. it protects heart aginst hyperlipidemia and arteriosclesoris. Also, totoal cholesterol levels are higher than normal 7.2. Arteriosclerosis could lead to myocardial infarction/heart attack. tri-vessel block to coronary artery called as coronary vessesl syndrome.

THe rised levels of Lactase dehydrogenase and creatine kinase is an indication of recent myocaridal infarction. The patient should be performed with emergency test of CK-MB (specific to cardiac muscles) and Troponin to confirm the diagnosis of myocaridal infarction.

one more risk is increased levels of fructosamine (351), because fructose is only digested by liver which inturn stimulates pancreas for insulin, inturn dangering insulin resistance diabestes and obesity.

In all a low sodium, low salt, low oil consumption diet is recommended, drugs for lowering cholesterol such as statins should be started. Foods which have fructose should be not consumed at all.