NFNF1613 HUMAN BIOCHEMISTRY FACULTY OF PHARMACY NATIONAL UNIVERSITY OF MALAYSIA SEMESTER 1 2022/2023 Name: Nurul Afiqah Izzati binti Roslan Matric Number.: A196598 Topic: Hyperlipidaemia Case Study Report JK is a 63-year-old woman with a blood pressure of 110/70 mm Hg and hyperlipidaemia with LDL-C of 4.1 mmol/L, HDL-C of 1.26 mmol/L, and triglycerides of 2.1 mmol/L. She was taking pravastatin, 20 mg/d for her medication. She reported that she did not feel good on atorvastatin, 40 mg/d, and she was hesitant to try a third-generation statin. She also stated that the atorvastatin can induce diabetes which concerned her that the statin might put her at a higher risk of diabetes. The laboratory results for her fasting blood glucose (FBG) are 5.8 mmol/L and 5.9% for her haemoglobin A1C (HbA1C) test. JK’s body mass index (BMI) is 31 kg/m^2 and her waist circumference is 91.5 cm. Both of her parents developed Type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) in their early 60s. Lastly, her ACC/AHA 10-year ASCVD risk score is 7.8%. Hyperlipidaemia is a condition in which there are excess lipids or fats in the blood. There are two types of hyperlipidaemia, excess cholesterol in the blood will cause hypercholesterolemia whereas excess triglycerides will result in hypertriglyceridemia. This condition is very common and can cause serious implications to the patient and possibly lead to mortality. Hyperlipidaemia is one of the major risk factors for ASCVD. It has been the leading cause of mortality in both Malaysian men and women for more than a decade. Atherosclerosis is a disease in which plaque forms inside the arteries. As a result, the shear force of the blood flow increases as the accumulated plaque constricts the lumen of the blood vessel. If the shear force is too high, the plaque may eventually rupture and cause the formation of a thrombus (blood clot), possibly leading to myocardial infarction. ASCVD is commonly associated with a high level of low-density lipoprotein (LDL) and a low level of high-density lipoprotein (HDL) in the blood. LDL-C is known as the ‘bad’ cholesterol because it builds up most cholesterol in the body. While HDL-C is called the ‘good’ cholesterol because it helps prevent atherosclerosis by carrying cholesterol from the peripheral tissue to the liver for removal. The high level of LDL in the blood increases the risk of the formation of hardened atherosclerotic plaque in the arteries which may lead to ASCVD. If the HDL level is too low, the cholesterol from the foam cells in the arteries cannot be removed to the liver and as a result, the plaque continues to grow and accumulate within the arteries. This will cause a blockage of blood flow to the other part of the body. As a result, vital organs like the brain and heart are oxygen deprived. The risk of the acute coronary syndrome, myocardial infarction, angina, and stroke increases as the blood flow decreases. The 10-year ASCVD risk score is a calculation to predict the 10-year risk of having a cardiovascular disease like myocardial infarction, coronary artery disease or stroke. Risk factors like age, sex, race, cholesterol level, systolic and diastolic blood pressure, antihypertension treatment, medications, diabetic status, and smoking status are considered in the calculation. However, the risk score can be sometimes overestimated or underestimated because of the limited risk factors. JK’s risk score of 7.8% cannot be considered as ‘intermediate risk’ because she has risk-enhancing factors that could affect her 10-year ASCVD risk score. The risk-enhancing factor is a family history of diabetes mellitus (DM) and ASCVD where both of her parents developed Type 2 DM and ASCVD in their early 60s. A family history of premature ASCVD is usually associated with an increased risk of CVD. Besides that, metabolic syndrome could also be one of the risk-enhancing factors because JK’s waist circumference is 91.5 cm. Therefore, she cannot has 7.8% as her risk score because it will reflect the treatment to be received by her. The high cholesterol level in the blood can be reduced by taking statins medication. It operates by inhibiting the secretion of a liver enzyme that produces cholesterol in the body to decrease the risk of ASCVD. However, atorvastatin and third-generation statins may increase the risk of developing Type 2 DM by altering glucose homeostasis, which results in cells being more resistant to insulin. Insulin resistance happens when cells in the muscles, fat, and liver become less effective in the uptaking of glucose from the blood. As a result, the blood glucose level is elevated which, over time, induces Type 2 DM. Individuals that consume statins with one or more major diabetes risk factors are at higher risk of developing diabetes compared to those without a major risk factor. This situation applies to JK because of her family history in which both of her parents developed Type 2 DM in their early 60s. Therefore, she avoids taking atorvastatin or third-generation statins as a safety measure. Alternatively, she consumes pravastatin for her medication because pravastatin was found to improve insulin sensitivity. This prevents the blood glucose level from rising too high.
