Interactive diabetes case 14: A 41-year-old patient with type 2 diabetes and hypertriglyceridemia – A1

ANSWER — Incorrect.

The patient is certainly at high risk for cardiovascular disease and may need a statin in the future. However, it is not possible to calculate the low-density lipoprotein (LDL) cholesterol level at present because of the markedly elevated triglyceride level. Some of the elevation of the serum cholesterol level in patients with hypertriglyceridemia reflects the cholesterol content of triglyceride-rich lipoproteins such as very low-density lipoprotein (VLDL).

Thus, we do not know the baseline LDL cholesterol level, and it will be difficult to determine whether the statin actually lowers the cholesterol or to what extent it does so. The patient may have hypertriglyceridemia without hypercholesterolemia. While a statin may produce a mild fall in the triglyceride level in a patient with a more modest degree of hypertriglyceridemia, it is unlikely to have a meaningful effect on the current triglyceride level. The present triglyceride level may reflect the patient's high fat and high carbohydrate intake and may reflect uncontrolled diabetes.

In the present patient, it is appropriate to approach the lipid disorder in an iterative manner, addressing first the roles of diet and uncontrolled diabetes. After this has been done, one can then determine the LDL cholesterol level and decide about the need for pharmacologic treatment of the hyperlipidemia.

Return to the beginning to try again. (See "Interactive diabetes case 14: A 41-year-old patient with type 2 diabetes and hypertriglyceridemia".)