The Gilbert Family
last authored: Feb 2011, David LaPierre
last reviewed:
used with permission, Victoria Shephard
The Gilberts are a family of three - John, Hilda, and their adult son Fred, all of whom are patients of yours in your rural Canadian practice. Though the parents are unhealthy (obesity, hypertension, diabetes, smoking, and other lifestyle factors), none of them have heart disease.
As you are very interested in preventing the development, and progression, of chronic disease in your patients, you try your best to screen for risk factors and treat them appropriately.
Screening
Fred Gilbert, 27, comes in to your practive. Given the state of his parents, he works hard to stay healthy. He eats well, does not smoke, and has a BMI of 24.
He inquires as to whether he should have cholesterol checked as a part of his routine annual health exam.
Do you offer him screening?
In Canada, the recommendations are:
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all patients with:
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In the US, recommendations are to screen all patients over 20 every five years or more frequently if reasons exist.
Hilda Gilbert, 54, is overweight, smokes, has an untreated blood pressure of 132/82, but does not have diabetes. Her lipid values are HDL 1.1 mmol/L, LDL 3.4 mmol/L, and total cholesterol 5.2. This gives h
What is her Framingham Risk Score? What risk level is she in? (online calculator)
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Should she be treated?
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What other lab test might guide you?
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John Gilbert, 58, has diabetes, hypertension (136/86 treated), and smokes. His HDL is 1.0 mmol/L, LDL is 4.4 mmol/L, and total cholesterol is 6.2 mmol/L.
What is his Framingham Risk Score? What risk level is he in? (online calculator)
answer (hover mouse over for 2 seconds)
What are his lipid goals?
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You are concerned that John is not at his target goals and decide to proceed with treatment.
What lifestyle treatments should be offered?
Lifestyle change support should include:
- smoking cessation
- diet, exercise
- reduced alcohol intake
- stress reduction
What medication treatments may be offered?
Statins are first-line treatments. These should be offered as monotherapy first.
Second-line agents, which may be used in combination, include:
- niacin
- ezitimibe
- cholestyramine and colestipol (cholesterol absorption inhibitors)
- fibrates
Resources and References
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