Use of Lifestyle Modifications for Management of a Patient with Severely High Total Cholesterol (> 14 mmol/L) and Triglycerides (> 40 mmol/L)

Abstract

In this report, we describe a case of a 37-year old man who presented with a history of total cholesterol > 14 mmol/L and triglyceride levels > 40 mmol/L. The patient was initially thought to have familial hypercholesterolemia due to his elevated total cholesterol, by his family physician. He was prescribed evolucumab, a proprotein convertase subtilisin/ kexin type 9 inhibitor drug which has shown efficacy for lowering low-density lipoprotein-cholesterol levels, to reduce his high total cholesterol. However, in this patient, the elevated total cholesterol was likely due to hypertriglyceridemia, rather than increased low-density lipoprotein-cholesterol levels. Through this case we provide an approach for the clinical management of patients with elevated total cholesterol with underlying triglycerides ≥ 10 mmol/L. The primary intervention for management of triglycerides ≥ 10 mmol/L involves lifestyle modifications including, changes in diet, exercise, reduction in body mass index, and abstinence from alcohol consumption. Secondary intervention involves management through pharmacotherapy with fibrates and statins. Creating a plan of action with the patient, incorporating lifestyle modifications alone, the patient was able to reduce the triglycerides from an average of 44.94 mmol/L to 3.28 mmol/L.

Keywords: Cholesterol; Lifestyle; Patient care management; Triglycerides.

Fig. 1

Management of Triglycerides. Shown here are pearls of clinical management of patients with triglycerides ≥ 10 mmol/L. Lifestyle modifications involving diet, alcohol and exercise should be the first line therapy. Management of pharmacotherapy that reduce triglycerides should be considered secondary to or alongside lifestyle modifications. EPA: Eicosapentanoic acid.