a very important question to discuss ---why? - flowerflower

[ArchivalUser]

A 65-year-old woman is admitted to the hospital with unstable angina. Cardiac catheterization shows stable coronary artery disease, which does not require coronary artery bypass graft. Her history includes coronary artery disease and stable angina controlled with medications. She has also followed a low-fat diet. Her medications include metoprolol, 50 mg twice daily; aspirin, 81 mg daily; and isosorbide dinitrate, 20 mg three times daily. She is not experiencing any further chest pain.

Laboratory Studies
Serum troponin

Normal
Serum total cholesterol

164 mg/dL (4.24 mmol/L)
Serum triglycerides

120 mg/dL (1.35 mmol/L)
Serum high-density lipoprotein cholesterol

50 mg/dL (1.29 mmol/L)
Serum low-density lipoprotein cholesterol

90 mg/dL (2.33 mmol/L)

Which of the following is the most appropriate next step in the management of this patient?

A Low-cholesterol diet
B Exercise program
C Niacin therapy
D Statin therapy

[ArchivalUser]

D
coz if you have CAD than you have to keep the LDL < 100

[ArchivalUser]

LDL is already less than 100

but should be less than 70 in some high risk groups like 1. HTN,DM,smoking 2. acute coronary syndrome 3. metabolic syndrome.

the patient admitted with the Dx of unstable angina which is type of coronary syndrome so DDDDDDDDDDDDD

[ArchivalUser]

The recommended LDL-C treatment goal in these patients is

[ArchivalUser]

If baseline LDL-C is 70 to 100 mg/dL, it is now reasonable to lower it to

[ArchivalUser]

70

[ArchivalUser]

even in patients with stable angina?

[ArchivalUser]

so far I knew that if you have CAD LDL should be less then 100 and this patient has 90 but the point in here is that if patient has acute CAD syndromes and hospitalized, statin should be started in the hospital

so is that true 'If baseline LDL-C is 70 to 100 mg/dL, it is now reasonable to lower it to 70 mg can you tell me your source.

Here is the explanation though

Several recent studies have shown that early treatment with a statin is associated with decreased mortality and morbidity in patients with acute coronary syndrome, manifested as unstable angina in this case. Treatment should be initiated while the patient is in the hospital, if possible. In one recent study, investigators compared standard treatment (pravastatin, 40 mg daily) with intensive treatment (atorvastatin, 80 mg daily) in patients with acute coronary syndrome. Serum low-density lipoprotein cholesterol levels decreased to 95 mg/dL (2.46 mmol/L) in the standard-treatment group and to 62 mg/dL (1.6 mmol/L) in the intensive-treatment group. After an average of 24 months, fewer deaths and vascular problems (myocardial infarction, unstable angina requiring hospitalization, revascularization, and stroke) occurred in the intensive-treatment group (22.4%) than in the standard-treatment group (26.3%).

Although a low-cholesterol diet and an exercise program are important in reducing this patient's long-term risk for coronary artery disease, these interventions would not have the greatest impact on her outcome in the near future. Niacin would lower triglyceride levels, which is not necessary because this patient's triglyceride level is acceptable.

[ArchivalUser]

D

according to kaplan CK --> CHRONIC stable CAD will likely need to be on statin unless contraindicated REGARDLESS OF THEIR LIPID LEVEL ( page 106 ck kaplan)

[ArchivalUser]

D Statin lowers mortality. Shoulde be used to help maintain this pt