A 52-YEAR-OLD MAN

Introduction
Since the last four decades, cardiovascular disease (CVD) has risen and has become a leading
cause of mortality and morbidity. (Thom et al., 2006) The wide literature proposes an increase in
CVD risk prevalence due to several factors such as metabolic syndrome, obesity, and diabetes.
(Declining Prevalence of No Known Major Risk Factors for Heart Disease and Stroke Among
Adults—United States, 1991-2001, 2004) These factors have reversed the downward trends in
CVD morbidity.

Understanding the lifetime risks of CVD is crucial because it provides absolute risk assessment.
Patients and clinicians to motivate important changes in health behaviors and lifestyles can easily
interpret these risks assessment. The well-defined cohorts of Framingham Heart Study and long-
term follow-up will help to examine lifetime risks of CVD. There are many short-term risks of
CVD; however, the effects of long-term risks are unpredictable.

Recently, public and clinical health can reduce the risks of cardiovascular disease. It can help to
emphasize the importance of pf integrating short-term global CVD risks. (Expert Panel on
Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, 2001) In some
developed countries, people who have low CVD risks might develop a high risk for the rest of
their lives. (Berry et al., 2009)

The estimation of the long-term risks of CVD can provide a comprehensive inspection of
diseases. This is mainly because of accounting long-term cardiovascular risks and other
competing risks. Nonetheless, these risks only matter until people reach an advanced age.
(Gaynor et al., 1993)

Assessing the future risks of cardiovascular diseases

The man already has an abnormal lipid profile. This means that he has some Lp(a) accumulated
in his body and some LDL that might induce the risks of CVD. Additionally, the man is a non-
smoker; therefore, there will be no other source of CVD. Moreover, he is not diabetic, and all the
symptoms of CVD can be solely attributed to an abnormal lipid profile.

On the other hand, it is stated that his family has a history of premature cardiovascular disease.
The patient might develop CVD later in his life because CVD is an inherited disorder. If he does
not have any CVD risks now, it does not mean he will be immune to CVD. However, he can
control or prolong the disease by maintaining a healthy lifestyle, diet, and care.
Total cholesterol level measures the cholesterol content of the blood sample. If the concentration
is high, it can pose CVD. The advisable cholesterol level is less than 5.2 mmol/L. Low-density
lipoprotein (LDL) cholesterol is referred to as the bad cholesterol because it can build up plaque
in your arteries. The accumulated plaque can rupture blood vessels and cause CVD. The
advisable LDL level is less than 3.4 mmol/L. If the person is diabetic then the LDL level must be
lower than 2.6 mmol/L. On the other hand, if the patient has a prior heart attack record the
advisable level is less than 1.8 mmol/L. High-density lipoprotein (HDL) cholesterol is referred to
as the good cholesterol because it can remove accumulated bad cholesterol thereby keeping the
arteries wide and free from lipids. Men should have an HDL level of more than 1.0 mmol/L,
while women should have an HDL level of more than 1.3 mmol/L.

Comparing it with the man’s test result, he has a more than average concentration of cholesterol,
which might be an early sign of CVD. The benchmark for HDL is 1.0 mmol/L and the man has
the exact one, it means that his body needs more good cholesterol to get rid of lipid
accumulations, if any.

Markers for successful statin treatment

Statins are a family of drugs that are used for reducing the cholesterol level in the body. If
cholesterol levels are reduced, people can prevent the risks of strokes and heart attacks.
According to research, the use of statins can reduce the likelihood of a heart attack by more than
30 percent. Statin drugs function by blocking the liver cells to produce cholesterol synthesizing
enzymes. If the cholesterol level becomes more than average, it might accumulate on internal
arterial walls and result in blood clots, narrow arteries, heart attack, and stroke. Statins not only
reduce cholesterol levels and LDL cholesterol levels but increase the concentration of HDL
cholesterol.

As a result, statins are widely used to lower lipid levels. The 2013 AHA cholesterol guidelines
provided a rough draft of the effect of fixed-dose statins. Statin intolerance can be detrimental to
manage and diagnose CVD. Several therapeutic strategies can be used to achieve statin
tolerance. However, the increased use of statins can elevate the risks of diabetes. (Abdullah and
Rohatgi, 2014)

There are numerous experiments performed to reduce the risks of atherosclerotic cardiovascular
disease (ASCVD). In some of the experiments, there was a reduction of 1.0 mmol/L in low-
density lipoprotein. In general, statins reduced the likelihood of heart attacks and CVD up to
21%. (Gersh, 2011) In the last two decades, scientists have invented efficient statins that are
effective in people in the range of 18-64 years. The countries of Organisation for Economic Co-
operation and Development (OECD) concluded that the use of statins has tripled since 2000. As
of 2013, the invention of AHA cholesterol guidelines has dramatically approached the Adult
Treatment Panel III (ATP III), which has reduced the CVD risks due to increases in statin
treatment. (Cheng and Leiter, 2006)

As per the recent guidelines, the pool of population is increasing. In comparison to conventional
statin treatment, patients can be classified into four groups: very high, high, average, and low
risks of CVD. The increasing use of statin treatment challenged the providers for a better
practical consideration.

The new lipid profile test can be used as indication markers in the patient. If he starts using statin
treatment, his cholesterol, triglycerides, and low-density lipoprotein level will decrease. Statin
medicines are very effective and the patient will see considerable changes in a short period.
Similarly, the high-level lipoprotein level will increase. As a result, his abnormal lipid profile
will become average.

Why might a patient with “normal” LDL be at high risk of future cardiovascular
disease?
A rise in low-density lipoprotein (LDL) concentration, also referred to as the bad cholesterol, is
the prime cause of the cardiovascular disease (CVD). Even a normal concentration of LDL in
aged patients can cause lipids to accumulate at the arterial walls, thereby reducing the consistent
flow of blood. This leads to CVD, heart attack, and angina. (LDL Cholesterol & Heart Health,
2020)

High CVD risk with normal LDL concentrations

Normal LDL concentrations are not harmful in people, but other factors can elevate the risk of
CVD. The first factor that might increase the CVD risk with even normal LDL concentration is
diabetes. Patients with diabetes have varying concentrations of glucose and glucagon. As a
result, their lipid concentration varies, if it exceeds then it accumulates at arterial walls.
Secondly, hypertension can increase the risks of CVD. If a person has a high blood pressure,
there would be two factors to increase the risks of atherosclerosis: LDL itself and high blood
pressure. Smoking factor also influences the risk percentage of CVD, Smokers have a high risk
of developing heart-related issues that might boost the CVD.

On the other hand, if a patient is obese and has more fats in his body, he will have a very high
risk of developing hypertension. Moreover, the person will have a high cholesterol level, which
might make the lipid profile abnormal. These abnormalities will result in atherosclerosis, lipid
accumulation at arterial walls, and high risks of CVD.
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