Sam's Case Study*

Initial Presentation

A 49-year-old male who is overweight and has no known history of heart disease.

Physical Examination

BMI: 28.5
Height: 6'0"
Weight: 210

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
1851	114	37	150	181
High > 1600	Within normal limits < 130	Desirable > 40	Desirable < 150	Desirable < 200

LDL-P Ranges1 (nmol/L)

Initial Intervention

Started rosuvastatin 10 mg. Patient instructed to adopt Mediterranean-American diet and exercise 1 hour a day 5 days per week.

Notes / Comments

Schedule 3-month follow-up.

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

Patient has been compliant with medication and diet and has lost 25 lbs walking 3 miles per day, 5 days per week.

PHYSICAL EXAMINATION

BMI: 25.1
Height: 6'0"
Weight: 185

CURRENT MEDICATION:

Rosuvastatin 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
702	62	45	62	119
High > 1600	Within normal limits < 130	Desirable > 40	Desirable < 150	Desirable < 200

LDL-P Ranges1 (nmol/L)

3-MONTH INTERVENTION

Patient instructed to continue with rosuvastatin and maintain diet and exercise.

Notes / Comments

Schedule 6-month follow-up to assess response to therapy and ensure LDL-P remains below 1000.

Managing Sam’s LDL-P*
9-MONTH FOLLOW-UP

Patient has been compliant with medication, but has stopped exercising over the holidays and has gained 10 lbs.

PHYSICAL EXAMINATION

BMI: 26.4
Height: 6'0"
Weight: 195

CURRENT MEDICATION:

Rosuvastatin 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
1201	77	53	187	167
High > 1600	Within normal limits < 130	Desirable > 40	Desirable < 150	Desirable < 200

LDL-P Risk Ranges1 (nmol/L)

9-MONTH INTERVENTION

No changes in pharmaceuticals.

Notes / Comments

Patient instructed to continue medication and return to diet and exercise routine. Schedule 6-month follow-up.

Managing Sam’s LDL-P*
15-MONTH FOLLOW-UP

Patient has been compliant with medication, has resumed exercising, and has lost 10 lbs.

PHYSICAL EXAMINATION

BMI: 25.1
Height: 6'0"
Weight: 185

CURRENT MEDICATION:

Rosuvastatin 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
793	59	51	81	126
High > 1600	Within normal limits < 130	Desirable > 40	Desirable < 150	Desirable < 200

LDL-P Ranges1 (nmol/L)

15-MONTH INTERVENTION

No changes in pharmaceuticals.

Notes / Comments

Patient instructed to continue medication and return to diet and exercise routine. Schedule 6-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

Bryan'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 Bryan’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 Bryan’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

Sam's Case Study*

Initial Presentation

Physical Examination

CURRENT MEDICATION

Initial Intervention

Notes / Comments

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

PHYSICAL EXAMINATION

CURRENT MEDICATION:

3-MONTH INTERVENTION

Notes / Comments

Managing Sam’s LDL-P* 9-MONTH FOLLOW-UP

PHYSICAL EXAMINATION

CURRENT MEDICATION:

9-MONTH INTERVENTION

Notes / Comments

Managing Sam’s LDL-P* 15-MONTH FOLLOW-UP

PHYSICAL EXAMINATION

CURRENT MEDICATION:

15-MONTH INTERVENTION

Notes / Comments

LDL Particles Cause Plaque2

Plaque Progression: More LDL Particles = More Plaque

Bryan's Case Study*

Initial Presentation

PHYSICAL EXAMINATION

CURRENT MEDICATION

Initial Intervention

Notes / Comments

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

PHYSICAL EXAMINATION

CURRENT MEDICATION:

3-MONTH INTERVENTION

Notes / Comments

Managing Bryan’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

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

Managing Sam’s LDL-P*
9-MONTH FOLLOW-UP

Managing Sam’s LDL-P*
15-MONTH FOLLOW-UP

LDL Particles Cause Plaque²

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

Managing Bryan’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