Introduction: 

Even cardiometabolic experts don’t have all the answers and often in medicine there’s more than one approach that may be correct. This is where the art and science of medicine intersect.

As we come across thought provoking cases in the cardiometabolic clinic, they will be presented here - for learning, for sharing and for hypothesis generating discussion.

Some cases may be truly unique and unknown. Others may illustrate common issues that arise but with questions or concepts that promote learning.

Case 1:

A 71 year old male is referred to the lipid clinic for moderately elevated CAC 251, which increased from a score of 119 on a CAC CT scan 2 years prior. Baseline LDL-C was 53 mg/dL, which has increased slightly to 65 mg/dL, non-HDL-C increased from 70 mg/dL to 84 mg/dL over last 7 years, ApoB is 62 mg/dL, Lp(a) is 26 nmol/L. 

He is presently not on any lipid lowering therapy. He has a remote smoking history of 1/2 ppd in his 20’s for about 10 years. 

PMHx: Pernio (like Raynaud’s) controlled on nifedipine

No Family Hx of ASCVD

Pertinent laboratory data: ESR, hsCRP low. 

BMI 24

Exercise history: moderately active

What to do? 

Q&A:

Coming soon