Case Study 1

Sample A is from a 35 year old male who visited his GPcomplaining of chest pain during exercise. An ECG taken at rest wasnormal but ischaemic changes developed on exercise. A familyhistory revealed that his father died of a heart attack at the ageof 45 years. The laboratory test results for hisfasting blood sample were as follows:

Analyte                      Patientvalues                       Reference range for fasting

     blood sample

Sodium                                   139                             135-145 mmol/L

Potassium                               4.1                             3.0-5.0 mmol/L

Totalprotein                          69                              65-80 g/L

Albumin                                 35                               35-47 g/L

Calcium                                 9.3                              9.0-10.5 mg/dl

Lactatedehydrogenase          250                             90-190 IU/L

Creatinekinase                      129                             30-60 IU/L

Asparatatetransaminase        70                               < 40 IU/L

Gamma glutamyl transferase30                               < 50 IU/L

TotalBilirubin                       13                               0.4-15 μmol/L

Glucose                                  12                               3.5-5.5 mmol/L

Fructosamine                         351                             205-285 μmol/L

Cholesterol                             

           Total                           7.2                              <5.2mmol/L

           HDL                          1.4                             >1.5 mmol/L

           LDL                           ?                                 <3.5 mmol/L

Triglycerides                         2.95                            <1.7mmol/L

On the gradient gel electrophoresis, plasma sample for thispatient showed the presence of small dense LDL particle.

1. Calculate and comment on the LDL cholesterol values. What doesthe presence of small dense LDL mean?
2. How many cardiovascular risk factors does this patient have?
3. Discuss the type of hyperlipidaemia this patient is likely tohave.
4. What further tests and dietary/drug treatments would yourecommend for this patient?