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Patient TP Female 40-year-old Caucasian female; PMH: HTN, obesity,…

- - - - Non-Pharmacologic
        
        Goal: Reduce overall mortality
        
        Diet
        Consume vegetables, fruits, whole grains, legumes, and non-tropical vegetable oils
        Healthy protein sources: Low-fat dairy, low-fat poultry without skin, fish/seafood, nuts
        Limit red meats, sweets, and sugar-sweetened beverages
        Lowers triglycerides
        
        Physical Activity
        3 - 4 sessions/week of moderate-to-vigorous intensity aerobic activity (40 min/session)
        Lowers triglycerides
        
        Weight Loss
        Every 10 lbs of weight loss increases HDL-C by approximately 1.6 mg/dL
        
        Smoking Cessation
        Increases HDL-C
      - Pharmacologic
        
        Initiate moderate intensity statin: Simvastatin 20 mg PO at night
        (dose can range from 20 - 40 mg)
        
        Monitoring
        
        Lipid Panel
        Baseline
        4 - 12 weeks after initiation or dose adjustment
        Every 3 - 12 months as needed thereafter to assess adherence or safety
        
        ALT
        Baseline
        Not routine unless s/sx of hepatotoxicity
        
        CPK
        S/Sx of myopathy
        
        A1c
        Baseline since DM status is unknown
        
        Other options:
        Atorvastatin 10 - 20 mg
        Rosuvastatin 5 - 10 mg
        Pravastatin 40 - 80 mg
        Lovastatin 40 mg
        Fluvastatin XL 80 mg
        Pitavastatin 2 - 4 mg
        
        Follow-up
        Check in 4 -12 weeks to see if statin therapy is lowering LDL
        
        Goal: Reduce LDL-C by 30 - 50%