Evidence-based Lipid Practice Case Rubric
Case Study #1 – 10 points
Presentation
JB is a 53-year-old Caucasian female. She was referred by her cardiologist for hypertriglyceridemia
(HTG). She was diagnosed with HTG several years ago. Her cardiologist prescribed a statin for
treatment of HTG, but the patient c/o adverse effects and discontinued the statin. She c/o adverse
effects with a trial of a second statin, as well as with Rx omega-3 acid ethyl ester. Historically, she
strictly followed the South Beach Diet for HTG treatment with some success (“TG decreased to 400s”).
In the summer of 2018, she had been limiting CHO-containing foods and exercising regularly and lost
10 lbs. During fall 2018 and spring 2019, life stressors have disrupted her lifestyle efforts and she feels
she has gained some weight back. On a scale of 1-10, JB stated she is at a “10” in terms of readiness
and confidence to address the stress in her life.
Medical Hx
• HTN; metabolic syndrome; no diabetes; no clinical ASCVD
• History of “patient-reported” statin intolerance: simvastatin – c/o memory
changes; rosuvastatin – experienced SOB after starting taking
• Other medication intolerances – experienced SOB after starting taking Rx
omega-3 acid ethyl ester; “violently ill” with some pain medications
Vitals
Ht: 5’ 9”; Wt: 170 lbs.; BMI: 25.1 kg/m2; BP: 128/90 mmHg
Social Hx
Never smoker; no alcohol intake; LDS religion; quite a bit of stress in life related to
helping husband with business and children’s life challenges
Family Hx
Mom and 2 sisters – “400+ mg TG and increased cholesterol”; mom deceased
from brain tumor
Another sister – deceased; T2D, heart failure, renal failure
Dad – MI @ age 68, T2D, heart failure, Alzheimer’s disease; deceased
Nutrition/Dietary Hx Tries to limit CHO intake; followed South Beach Diet in the past with some success
Physical Activity Hx Currently walking; 6 months ago – gym 3x/week and Taebo 2x/week
Medications
Amlodipine 5 mg daily
Dietary supplement fish oil – one 1,400 mg capsule QHS (no c/o side effects)
Laboratory Values
Parameter
August 2018
May 2017
Total cholesterol
217 mg/dL
173 mg/dL
Triglycerides
834 mg/dL*
359 mg/dL*
HDL-C
24 mg/dL
29 mg/dL
LDL-C
NA
72 mg/dL
Non-HDL-C
193 mg/dL
144 mg/dL
Glucose
108 mg/dL
NA
HbA1c
NA
5.3%
0.943 uIU/mL
NA
TSH
*Highest TG level recalled by patient = 3,000 mg/dL
Evidence-based Lipid Practice Case Rubric
Case Study #1 – 10 points
Questions
1. Based on the information you have for JB, what is the most appropriate risk assessment tool to use
to determine her 10-year risk of ASCVD? (1 point)
2. Using the risk assessment tool you feel is appropriate, calculate JB’s 10-year ASCVD risk. (1 point)
3. Based on Ms. Ciffone’s lecture, what are JB’s major risk factors? (2 points)
4. Based on Ms. Ciffone’s lecture, what are JB’s additional risk factors? (1 point)
5. What are JB’s goals of therapy for lipid management? (1 point)
6. What other CV risk assessment and/or reduction approaches do you recommend? (1 point)
7. What health care professionals should be part of this patient’s care team (list at least 3) and what
would each team member do to ensure her ASCVD risk factors are addressed thoroughly and
appropriately? (3 points)
Risk Factors and
Risk Assessment
NICOLE CIFFONE, MSN, ANP-C, FNLA
CLINICAL LIPID SPECIALIST
Objectives
• Define Risk
• Discuss reasons for studying Risk
• Identify Risk Factors and Risk Markers that lead to the development and progression
of ASCVD
• Describe goals of screening
• Define the terms and metrics used for evaluation of screening
• Review assessment tools and imaging studies
• Case studies