Case 1

• 44 Year Old white woman with 10-year history of type 2 DM ,

Nonsmoker, well-controlled HTN on medications
Family history of DM but not premature ASCVD

• BP 135/78 mmHg and BMI 36 kg/m2

• Lipid panel:
TC 205 mg/dL
TG 350 mg/dL
LDL 165 mg/dL
HDL 38 mg/dL
• Hemoglobin A1C 7.5%

1) Based on the 2018 ACC/AHA Cholesterol Guideline, how would you

approach lipid management in this patient?
Case 2
52-Year Old white male. Not known to have any chronic disease. There
is no family history of DM or premature ASCVD.
He is heavy smoker

BP 138/88 mmHg and BMI 30 kg/m2

Lipid panel: TC 200 mg/dL - LDL 165mg/dL - HDL 33 mg/dL
Hemoglobin A1C 5.8%
Coronary artery calcium score = 0

1) Based on the 2018 ACC/AHA Cholesterol Guideline, how would you

approach lipid management in this patient?

2) How to interpret his Coronary artery calcium score?

Case 3
77-Year Old African American male known case of Ischemic heart
disease and DM. he is smoker and has family history of DM and
premature ASCVD

BP 142/80 mmHg and BMI 34 kg/m2

Lipid panel: TC 220 mg/dL - LDL 150mg/dL - HDL 35 mg/dL
Hemoglobin A1C 8.7%

1) Based on the 2018 ACC/AHA Cholesterol Guideline, how would you

approach lipid management in this patient?
Case 4
53Year old white woman not known to have any chronic illness. Her
father died suddenly at age 38 and her uncle had MI at age 32 . She
came to clinic because she have high cholesterol. She tried vegetarian
diet without success to lower her cholesterol but she never tried
medication before.

BP 135/84 mmHg - BMI 37 kg/m2

Lipid panel: LDL of 197 mg/dL - HDL 51 mg/dL - TG 102 mg/dL

1) Based on the 2018 ACC/AHA Cholesterol Guideline, how would you

approach lipid management in this patient?