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APRENDIZAJE BASADO EN UN CASO
A Case of Metabolic Syndrome and Elevated High-Sensitivity C-Reactive Protein: Approach to Management
Autor: Madhuri M. Vasudevan, MD, MPH
CASE
A 60-year-old postmenopausal mexican woman comes to the clinic for evaluation of her medical conditions. She has a 3-year history of hypertension and impaired fasting glucose and reports a gradual 40-pound weight gain after her second pregnancy. Although she has tried multiple diets, she has not had consistent, long-term success with weight loss
Past Medical History: Gestational diabetes during 2 pregnancies, impaired fasting glucose for 3 years and hypertenstion for 3 years
Medications: None
Past Surgical History: None
Family History: Mother diagnosed with diabetes at 45 years of age, father diagnosed with coronary artery disease and diabetes at 54 years of age
Her 26-year-old son and her 24-year-old daughter are both overweight and have never had their cholesterol checked
Diet: Eats fried foods twice weekly. does not restrict meal portions
Drinks at least 24 ounces of sweetened sodas daily. Believes her dietary habits are not that bad when compared to others in her family
Exercise: No regular exercise regimen
Limited by her 8-hr work day and 2-hr daily commute
Social History: Nonsmoker. Occasional alcohol intake (~4 glasses of wine per week)
Vital Signs: Blood pressure = 144/88 mmHg Heart rate = 78
Resting respiratory rate = 12 Temperature = 98.8 °F
Height = 5’6” Weight = 188 lbs
Waist circumference = 36” Body mass index = 30.3 kg/m2
General Appearance: overweight, no apparent distress. Neck: no thyromegaly; no carotid bruits. Cardiovascular: regular rate and rhythm; no murmurs. Extremities: no edema; pulses normal
LAB
Total cholesterol = 226 mg/dL
Triglycerides = 285 mg/dL
High-density lipoprotein cholesterol = 38 mg/dL
Low-density lipoprotein cholesterol = 117 mg/dL
Aspartate aminotransferase = 38 U/L (range 10–35 U/L)
Alanine aminotransferase = 62 U/L (range 6–40 U/L)
Glucose = 116 mg/dL
Non–high-density lipoprotein cholesterol = 174 mg/dL
High-sensitivity C-reactive protein = 6 mg/L (normal limit <2>ANSWER THE QUESTIONS:
According to AHA/NHLBI criteria, how many components of the metabolic syndrome does this patient have?
According to the Framingham 10-year coronary heart disease (CHD)-risk assessment, what is the patient’s risk for developing cardiovascular disease in the next 10 years?
Based on the patient’s risk for coronary heart disease, what is the recommended goal for low-density lipoprotein cholesterol?
What secondary target should be met in a person classified as being at moderate risk for coronary heart disease?
Does the Framingham risk score assessment for coronary heart disease include family history?
Comments about treatment
Autor: Madhuri M. Vasudevan, MD, MPH
CASE
A 60-year-old postmenopausal mexican woman comes to the clinic for evaluation of her medical conditions. She has a 3-year history of hypertension and impaired fasting glucose and reports a gradual 40-pound weight gain after her second pregnancy. Although she has tried multiple diets, she has not had consistent, long-term success with weight loss
Past Medical History: Gestational diabetes during 2 pregnancies, impaired fasting glucose for 3 years and hypertenstion for 3 years
Medications: None
Past Surgical History: None
Family History: Mother diagnosed with diabetes at 45 years of age, father diagnosed with coronary artery disease and diabetes at 54 years of age
Her 26-year-old son and her 24-year-old daughter are both overweight and have never had their cholesterol checked
Diet: Eats fried foods twice weekly. does not restrict meal portions
Drinks at least 24 ounces of sweetened sodas daily. Believes her dietary habits are not that bad when compared to others in her family
Exercise: No regular exercise regimen
Limited by her 8-hr work day and 2-hr daily commute
Social History: Nonsmoker. Occasional alcohol intake (~4 glasses of wine per week)
Vital Signs: Blood pressure = 144/88 mmHg Heart rate = 78
Resting respiratory rate = 12 Temperature = 98.8 °F
Height = 5’6” Weight = 188 lbs
Waist circumference = 36” Body mass index = 30.3 kg/m2
General Appearance: overweight, no apparent distress. Neck: no thyromegaly; no carotid bruits. Cardiovascular: regular rate and rhythm; no murmurs. Extremities: no edema; pulses normal
LAB
Total cholesterol = 226 mg/dL
Triglycerides = 285 mg/dL
High-density lipoprotein cholesterol = 38 mg/dL
Low-density lipoprotein cholesterol = 117 mg/dL
Aspartate aminotransferase = 38 U/L (range 10–35 U/L)
Alanine aminotransferase = 62 U/L (range 6–40 U/L)
Glucose = 116 mg/dL
Non–high-density lipoprotein cholesterol = 174 mg/dL
High-sensitivity C-reactive protein = 6 mg/L (normal limit <2>ANSWER THE QUESTIONS:
According to AHA/NHLBI criteria, how many components of the metabolic syndrome does this patient have?
According to the Framingham 10-year coronary heart disease (CHD)-risk assessment, what is the patient’s risk for developing cardiovascular disease in the next 10 years?
Based on the patient’s risk for coronary heart disease, what is the recommended goal for low-density lipoprotein cholesterol?
What secondary target should be met in a person classified as being at moderate risk for coronary heart disease?
Does the Framingham risk score assessment for coronary heart disease include family history?
Comments about treatment
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