Edward's Case Study*

Initial Presentation

A 42-year-old male. Strong family history of premature atherosclerotic CVD. Father had fatal MI at 51.
Brother had nonfatal MI at 45.

PHYSICAL EXAMINATION

BP: 104/66
Height: 6'2"
Weight: 203
Waist: 39
Exam otherwise unremarkable.10-Year Framingham Risk Score: 1%

CURRENT MEDICATION

None

Test Results

LDL Particle	LDL Cholesterol	HDL Cholesterol	Triglycerides	Total Cholesterol
LDL-P mg/dL	LDL-C mg/dL	HDL-C mg/dL	TG mg/dL	TC mg/dL
1809	94	24	142	146
High > 1600	Within normal limits < 130	Desirable > 40	Desirable < 150	Desirable < 200

LDL-P Ranges1 (nmol/L)

Initial Intervention

Started atorvastatin 20mg, referred to a dietician for formal instruction in Step II AHA diet.

Notes / Comments

Due to patient’s high risk for CVD, treatment goal is to reduce LDL-P to below 1000 nmol/L. Schedule 3-month follow-up.

Managing Edward’s LDL-P*
3-MONTH FOLLOW-UP

Patient has been compliant with all therapeutic lifestyle changes, has lost 5 lbs, and tolerates medication without complaints.

PHYSICAL EXAMINATION

BP: 106/70
Height: 6'2"
Weight: 198
Waist: 38
Exam otherwise unremarkable.

CURRENT MEDICATION:

Atorvastatin 20mg

Test Results

LDL Particle	LDL Cholesterol	HDL Cholesterol	Triglycerides	Total Cholesterol
LDL-P mg/dL	LDL-C mg/dL	HDL-C mg/dL	TG mg/dL	TC mg/dL
1137	84	27	96	125
High > 1600	Within normal limits < 130	Desirable > 40	Desirable < 150	Desirable < 200

LDL-P Ranges1 (nmol/L)

3-MONTH INTERVENTION

Added extended-release niacin 1000mg to atorvastatin 20mg.

Notes / Comments

Schedule 3-month follow-up. Continue to address LDL-related risk with treatment goal to below 1000 nmol/L, followed by management of HDL-C- and TG-related risk.

Managing Edward’s LDL-P*
6-MONTH FOLLOW-UP

Patient has been compliant with all therapeutic lifestyle changes and tolerates medication without complaints.

PHYSICAL EXAMINATION

BP: 107/70
Height: 6'2"
Weight: 198
Waist: 38
Exam otherwise unremarkable.

CURRENT MEDICATION:

Atorvastatin 20mg and extended-release niacin 1000mg.

Test Results

LDL Particle	LDL Cholesterol	HDL Cholesterol	Triglycerides	Total Cholesterol
LDL-P mg/dL	LDL-C mg/dL	HDL-C mg/dL	TG mg/dL	TC mg/dL
905	79	38	42	125
High > 1600	Within normal limits < 130	Desirable > 40	Desirable < 150	Desirable < 200

LDL-P Ranges1 (nmol/L)

6-MONTH INTERVENTION

No changes in pharmaceuticals.

Notes / Comments

Schedule 3-month follow-up, then continue to monitor patient quarterly.

LDL Particles Cause Plaque²

Plaque Progression: More LDL Particles = More Plaque

The higher the number of LDL particles, the greater the likelihood for them to enter the arterial wall and deposit their contents forming atherosclerotic plaque. Measurement of LDL-C on traditional lipid panels does not reflect LDL particle number.

Click HERE to download a PDF of LDL Particles Cause Plaque.

*These case studies represent patients with conditions contributing to cardiometabolic risk and have been provided by clinicians who use the NMR LipoProfile test — The Particle Test — routinely in their practices. These case studies are for informational purposes only and not for diagnostic use.
1. LDL-P Ranges are demonstrated in a representative sampling of the general population (n=5,362) enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA). Mora S, Szklo M, Otvos JD, Greenland P, et al. LDL particle subclasses, LDL particle size, and carotid atherosclerosis in the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2007;192:211-217. Each reporting laboratory should verify the validity of these values for the population it serves.
2. Brunzell JD, Davidson M, Furberg, CD, et al. LipoProtein Management in Patients with Cardiometabolic Risk. J. Am Coll. Cardiol. 2008;51;1512-24

Theresa's Case Study*

Initial Presentation

A 56-year old female.
Diabetic. Hypertensive. Non-smoker.

PHYSICAL EXAMINATION

BP: 102/72
Height: 5'4"
Weight: 168
BMI: 29

CURRENT MEDICATION

Atorvastatin 80mg, lisinopril, metformin, HCTZ

Test Results

LDL Particle	LDL Cholesterol	HDL Cholesterol	Triglycerides	Total Cholesterol
LDL-P mg/dL	LDL-C mg/dL	HDL-C mg/dL	TG mg/dL	TC mg/dL
1611	98	68	199	206
High > 1600	Within normal limits < 130	Desirable > 40	Desirable < 150	Desirable < 200

LDL-P Ranges1 (nmol/L)

Initial Intervention

Switched from atorvastatin 80mg to rosuvastatin 20mg.
Switched from metformin to pioglitazone HCl and metformin HCl 15/500 daily to help control triglycerides.

Notes / Comments

Instructed on weight loss efforts, including diet and exercise. Return in 6 weeks to assess response to therapy.

Managing Theresa’s LDL-P*
6-WEEK FOLLOW-UP

Patient compliant with medications and has lost 11 lbs through diet and exercise.

PHYSICAL EXAMINATION

BP: 102/72
Height: 5'4"
Weight: 157
BMI: 29

CURRENT MEDICATION:

Rosuvastatin 20mg, lisinopril, pioglitazone HCl and metformin HCl 15/500, HCTZ

Test Results

LDL Particle	LDL Cholesterol	HDL Cholesterol	Triglycerides	Total Cholesterol
LDL-P mg/dL	LDL-C mg/dL	HDL-C mg/dL	TG mg/dL	TC mg/dL
1137	60	73	145	162
High > 1600	Within normal limits < 130	Desirable > 40	Desirable < 150	Desirable < 200

LDL-P Ranges1 (nmol/L)

6-WEEK INTERVENTION

Added ezetimibe 10mg

Notes / Comments

Patient instructed to continue treatment, diet, and exercise. Schedule 6-week follow-up to assess response to therapy.

Managing Theresa's LDL-P*
12-WEEK FOLLOW-UP

Patient has been compliant with all therapeutic lifestyle changes, has lost an additional 6.5 lbs, and continues to diet and exercise.

PHYSICAL EXAMINATION

BP: 102/72
Height: 5'4"
Weight: 150.5
BMI: 29

CURRENT MEDICATION:

Rosuvastatin 20mg, lisinopril, pioglitazone HCl and metformin HCl 15/500, HCTZ, ezetimibe 10mg

Test Results

LDL Particle	LDL Cholesterol	HDL Cholesterol	Triglycerides	Total Cholesterol
LDL-P mg/dL	LDL-C mg/dL	HDL-C mg/dL	TG mg/dL	TC mg/dL
1070	51	67	80	134
High > 1600	Within normal limits < 130	Desirable > 40	Desirable < 150	Desirable < 200

LDL-P Ranges1 (nmol/L)

12-WEEK INTERVENTION

No changes in pharmaceuticals.

Notes / Comments

Patient instructed to continue current treatment and weight loss efforts. Schedule 3-month follow-up.

LDL Particles Cause Plaque²

Plaque Progression: More LDL Particles = More Plaque

The higher the number of LDL particles, the greater the likelihood for them to enter the arterial wall and deposit their contents forming atherosclerotic plaque. Measurement of LDL-C on traditional lipid panels does not reflect LDL particle number.

Click HERE to download a PDF of LDL Particles Cause Plaque.

*These case studies represent patients with conditions contributing to cardiometabolic risk and have been provided by clinicians who use the NMR LipoProfile test — The Particle Test — routinely in their practices. These case studies are for informational purposes only and not for diagnostic use.
1. LDL-P Ranges are demonstrated in a representative sampling of the general population (n=5,362) enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA). Mora S, Szklo M, Otvos JD, Greenland P, et al. LDL particle subclasses, LDL particle size, and carotid atherosclerosis in the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2007;192:211-217. Each reporting laboratory should verify the validity of these values for the population it serves.
2. Brunzell JD, Davidson M, Furberg, CD, et al. LipoProtein Management in Patients with Cardiometabolic Risk. J. Am Coll. Cardiol. 2008;51;1512-24

Lee's Case Study*

Initial Presentation

A 60-year-old male.

Hypertension. Dyslipoproteinemia.

PHYSICAL EXAMINATION

BP: 150/70
BMI: 26.3

CURRENT MEDICATION

Ramipril 10 mg, niacin/lovastatin combo 40/1000 mg, spironolactone/HCTZ 12.5/12.5 mg.

Test Results

LDL Particle	LDL Cholesterol	HDL Cholesterol	Triglycerides	Total Cholesterol
LDL-P mg/dL	LDL-C mg/dL	HDL-C mg/dL	TG mg/dL	TC mg/dL
1459	80	62	79	158
High > 1600	Within normal limits < 130	Desirable > 40	Desirable < 150	Desirable < 200

LDL-P Ranges1 (nmol/L)

Initial Intervention

Medication changed to rosuvastatin 10 mg and extended-release niacin 1,000 mg.

Notes / Comments

Schedule 3 month follow-up to assess response to therapy.

Managing Lee’s LDL-P*
3-MONTH FOLLOW-UP

Patient compliant with pharmacologic interventions, no change in BMI.

PHYSICAL EXAMINATION

BP: 150/70
BMI: 26.3

CURRENT MEDICATION:

Ramipril 10 mg, rosuvastatin 10 mg, extended-release niacin 1,000 mg, spironolactone/HCTZ 12.5/12.5 mg.

Test Results

LDL Particle	LDL Cholesterol	HDL Cholesterol	Triglycerides	Total Cholesterol
LDL-P mg/dL	LDL-C mg/dL	HDL-C mg/dL	TG mg/dL	TC mg/dL
953	86	63	62	135
High > 1600	Within normal limits < 130	Desirable > 40	Desirable < 150	Desirable < 200

LDL-P Ranges1 (nmol/L)

6-WEEK INTERVENTION

Patient instructed to continue with rosuvastatin 10 mg, extended- release niacin 1,000 mg.

Notes / Comments

Patient scheduled for follow-up test in 6 months to assess response to therapy and ensure they remain at LDL-P goal.

LDL Particles Cause Plaque²

Plaque Progression: More LDL Particles = More Plaque

The higher the number of LDL particles, the greater the likelihood for them to enter the arterial wall and deposit their contents forming atherosclerotic plaque. Measurement of LDL-C on traditional lipid panels does not reflect LDL particle number.

Click HERE to download a PDF of LDL Particles Cause Plaque.

*These case studies represent patients with conditions contributing to cardiometabolic risk and have been provided by clinicians who use the NMR LipoProfile test — The Particle Test — routinely in their practices. These case studies are for informational purposes only and not for diagnostic use.
1. LDL-P Ranges are demonstrated in a representative sampling of the general population (n=5,362) enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA). Mora S, Szklo M, Otvos JD, Greenland P, et al. LDL particle subclasses, LDL particle size, and carotid atherosclerosis in the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2007;192:211-217. Each reporting laboratory should verify the validity of these values for the population it serves.
2. Brunzell JD, Davidson M, Furberg, CD, et al. LipoProtein Management in Patients with Cardiometabolic Risk. J. Am Coll. Cardiol. 2008;51;1512-24

Edward's Case Study*

Initial Presentation

PHYSICAL EXAMINATION

CURRENT MEDICATION

Initial Intervention

Notes / Comments

Managing Edward’s LDL-P* 3-MONTH FOLLOW-UP

PHYSICAL EXAMINATION

CURRENT MEDICATION:

3-MONTH INTERVENTION

Notes / Comments

Managing Edward’s LDL-P* 6-MONTH FOLLOW-UP

PHYSICAL EXAMINATION

CURRENT MEDICATION:

6-MONTH INTERVENTION

Notes / Comments

LDL Particles Cause Plaque2

Plaque Progression: More LDL Particles = More Plaque

Theresa's Case Study*

Initial Presentation

PHYSICAL EXAMINATION

CURRENT MEDICATION

Initial Intervention

Notes / Comments

Managing Theresa’s LDL-P* 6-WEEK FOLLOW-UP

PHYSICAL EXAMINATION

CURRENT MEDICATION:

6-WEEK INTERVENTION

Notes / Comments

Managing Theresa's LDL-P* 12-WEEK FOLLOW-UP

PHYSICAL EXAMINATION

CURRENT MEDICATION:

12-WEEK INTERVENTION

Notes / Comments

LDL Particles Cause Plaque2

Plaque Progression: More LDL Particles = More Plaque

Lee's Case Study*

Initial Presentation

PHYSICAL EXAMINATION

CURRENT MEDICATION

Initial Intervention

Notes / Comments

Managing Lee’s LDL-P* 3-MONTH FOLLOW-UP

PHYSICAL EXAMINATION

CURRENT MEDICATION:

6-WEEK INTERVENTION

Notes / Comments

LDL Particles Cause Plaque2

Plaque Progression: More LDL Particles = More Plaque

Managing Edward’s LDL-P*
3-MONTH FOLLOW-UP

Managing Edward’s LDL-P*
6-MONTH FOLLOW-UP

LDL Particles Cause Plaque²

Managing Theresa’s LDL-P*
6-WEEK FOLLOW-UP

Managing Theresa's LDL-P*
12-WEEK FOLLOW-UP

LDL Particles Cause Plaque²

Managing Lee’s LDL-P*
3-MONTH FOLLOW-UP

LDL Particles Cause Plaque²