Saint Louis University

SCHOOL OF MEDICINE
Baguio City, Philippines

CASE BASED LEARNING EXERCISE

Clinical Application of the Laboratory Determination of Lipids

CASE
A 50 year old male complains of pain in the calf muscles during exercise along with coldness
and numbness in both legs. His symptoms have been occurring for a year and are relieved by
rest. The patient has also been impotent and has been experiencing abdominal pain about half an
hour after eating. He smokes two packs of cigarettes a day.
Physical examination reveals a blood pressure of 150/100, diminished peripheral pulses
bilaterally, loss of hair over dorsum of feet and hands, decreased temperature in the hands and
feet carotid and femoral arterial bruits, and atrophy of calf muscles.
Laboratory tests reveal an elevated LDL, decreased HDL, and elevated total serum cholesterol.

GUIDE QUESTIONS:

1. What vascular disease does this patient most likely have?

2. What are the causes of this vascular disease?

3. What is the initial approach for the evaluation of patients suspected to have this
vascular disease?

4. What are the most recent guidelines for the evaluation and monitoring of patients
with this vascular disease? (Discuss.)

5. How are the following tests used to evaluate cardiovascular risk? (Discuss and
include pre-analytical and analytical aspects when applicable.)
a) LDL cholesterol
b) HDL cholesterol
c) Total cholesterol
d) Non-HDL cholesterol
e) High sensitivity CRP

6. What is the metabolic syndrome? What are the parameters for this syndrome?

7. How can the risk for cardiovascular disease be calculated (or quantified)?

8. What genetic disorders are associated with high blood lipid levels?