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35 Year Old Male with Diabetes and Familial Hypertriglyceridemia

35 Year Old Male with Diabetes and Familial Hypertriglyceridemia. Case Categories Primary Prevention Secondary Prevention Pediatric Case Familial Hypertriglyceridemia Diabetes Metabolic Syndrome Low HDL Familial Combined Hyperlipidemia Familial Hypercholesterolemia

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35 Year Old Male with Diabetes and Familial Hypertriglyceridemia

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  1. 35 Year Old Male with Diabetes and Familial Hypertriglyceridemia Case Categories Primary Prevention Secondary Prevention Pediatric Case Familial Hypertriglyceridemia Diabetes Metabolic Syndrome Low HDL Familial Combined Hyperlipidemia Familial Hypercholesterolemia Elevated Lipoprotein (a) Statin Intolerance Case category: Diabetes, Familial Hypertriglyceridemia History of present illness: 35 year old male with diabetes and familial hypertriglyceridemia. Well controlled on Crestor 20, Niaspan 2000, Lovaza 6, metformin 2000, Actos 15, Victoza 1.8 and Cycloset 0.8 (LDL-P: 605, total cholesterol: 91, triglycerides: 121, HDL: 35.) Off medications for only 6 days prior to 3 month follow-up labs, lipid profile deteriorated. Here for follow-up.

  2. Patient Information

  3. Patient History

  4. Current Medications

  5. Labs Worth Noting Off Medications For 6 Days

  6. Questions to Consider • Question 1 • Question 2 • Question 3 • Question 4

  7. Labs off Medications for 6 Days (1 of 5)

  8. Labs off Medications for 6 Days (2 of 5)

  9. Labs off Medications for 6 Days (3 of 5)

  10. Labs off Medications for 6 Days (4 of 5)

  11. Labs off Medications for 6 Days (5 of 5)

  12. NMR LipoProfile • Insert NMR Lipoprofile 020812 PW76 Insert

  13. Initial Treatment & Management • Restart Crestor 20, Niaspan 2000 and Lovaza 6 for hypertriglyceridemia. • Restart CO Q 10 300-600 mg/day for muscle aching. • Restart metformin 2000, Victoza 1.8 and Cycloset 0.8 for diabetes control. • Restart Vitamin D2 50,000 weeklyfor vitamin D deficiency.

  14. Discussion (1 of 3)

  15. Discussion (2 of 3)

  16. Discussion (3 of 3)

  17. Follow Up on Crestor 20, Niaspan 2000, Lovaza 6, metformin 2000, Victoza 1.8, Cycloset 0.8 and Vitamin D2 50,000 / D3 10,000 (1 of 2) • Familial Combined hypertriglyceridemia – Improved. • Restarted Crestor 20, Niaspan 2000 and Lovaza 6. • LDL-P is now reduced from 1405 to 655. Total cholesterol is reduced from 279 to 84. Triglycerides dropped from 1072 to 252. HDL is now 30. IR Score was reduced from 100 to 74. • Continue therapy. • Diabetes Type 2 – Unchanged. • Restarted metformin 2000, Victoza 1.8 and Cycloset 0.8. • HbA1C remained the same at 7.7. • IR Score did lower from 100 to 74. Optimal is <45. • Continue therapy.

  18. Follow Up on Crestor 20, Niaspan 2000, Lovaza 6, metformin 2000, Victoza 1.8, Cycloset 0.8 and Vitamin D2 50,000 / D3 10,000 (2 of 2) • Vitamin D Deficiency – Improved. • Restarted vitamin D2 50,000 IU weekly and started vitamin D3 10,000 IU/day. • Levels increased from 12 to 54. • Continue therapy.

  19. Follow Up Labs on Medications (1 of 4)

  20. Follow Up Labs on Medications (2 of 4)

  21. Follow Up Labs on Medications (3 of 4)

  22. Follow Up Labs on Medications (4 of 4)

  23. NMR LipoProfile • Insert NMR Lipoprofile 030612 PW76 Insert

  24. Clinical Pearls

  25. Case Summary

  26. References (1 of 3) Familial Hypertriglyceridemia • KolovouGD, Anagnostopoulou KK, Kostakou PM, et al. Primary and secondary hypertriglyceridaemia. Curr Drug Targets. Apr 2009;10(4):336-43. • TalayeroBG, Sacks FM. The role of triglycerides in atherosclerosis. CurrCardiol Rep. 2011 Dec;13(6):544-52 • Nicholls SJ, Ballantyne CM, Barter PJ, et al. Effect of two intensive statin regimens on progression of coronary disease. N Engl J Med. 2011 Dec 1;365(22):2078-87. • Cromwell WC, Otvos JD, Keyes MJ, et al. LDL particle number and risk of future cardiovascular disease in the Framingham offspring study – implications for LDL management. J ClinLipidol. 2007 Dec;1(6):583-92. • Mora S, Szklo M, Otvos JD, et al. LDL particle subclasses, LDL particle size, and carotid atherosclerosis in the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis. 2007 May;192(1):211-7. • Roth EM, Bays HE, Forker AD, et al. Prescription omega-3 fatty acid as an adjunct to fenofibrate therapy in hypertriglyceridemic subjects. J CardiovascPharmacol. Jul 10 2009.

  27. References (2 of 3) Diabetes Type 2 • ADA Standards of Medical Care in Diabetes - 2012. Diabetes Care. Jan 2012 35(1)11-63. • Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998 Sep 12;352(9131):854-65. • Gaziano JM, Cincotta AH, O’Connor CM. Randomized clinical trial of quick-release bromocriptine among patients with type 2 diabetes on overall safety and cardiovascular outcomes. Diabetes Care. 2010 Jul;33(7):1503-8. • Pili H, Ohashi S, Matsuda M, et al. Bromocriptine: a novel approach to the treatment of type 2 diabetes. Diabetes Care. 2000 Aug;23(8):1154-61.

  28. References (3 of 3) Vitamin D Deficiency • Dobnig H, Pilz S, Scharnagl H, et al. Independent association of low serum 25-hydroxyvitamin d and 1,25-dihydroxyvitamin d levels with all-cause and cardiovascular mortality. Arch Intern Med. 2008;168(12):1340-1349. • Cannell J, Hollis B, Zasloff M, et al. Diagnosis and treatment of vitamin D deficiency. Pharmacotherapy. 2008;9(1):1-12. • Giovannucci E, Liu Y, Hollis B, Rimm E. 25-hydroxyvitamin d and risk of myocardial infarction in men. Arch Intern Med. 2008;168(11):1174-1180. • Holick M. Vitamin D Deficiency. N Engl J Med. 2007;357:266-81. • Michos E and Blumenthal R. Vitamin D Supplementation and Cardiovascular Disease Risk. Circulation. 2007;115(7):827-828. • Hathcock J, Shao A, Vieth R, et al. Risk assessment for vitamin D. Am J ClinNutr. 2007;85:6-18. • Jockers B. Vitamin D sufficiency: An approach to disease prevention. The American Journal for Nurse Practitioners. 2007;11(10):43-50. • Perez-Castrillon J, Vega G, Abad L, et al. Effects of atorvastatin on vitamin D levels in patients with acute ischemic heart disease. Am J Cardiol. 2007;99(7):903-4.

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