Please comment on this person's lipids page

[ShannonPA-S]

I am a physician assistant student on clinical rotations in internal medicine right now...in the heart of Detroit. I saw a 34 year old type 1 diabetic patient today. Her glucose is normally controlled pretty well, but lately it hasn't been because she ran out of testing strips and could not afford them. Last month when she was in, a classmate of mine rotating there drew labs including a lipid profile.

When I walked in today, I could tell the patient was worried. I introduced myself and went on to review her history. She said that she did not want to see "that other student" who was there last time because she yelled at her about her cholesterol being high. In fact, the patient brought her brother because it upset her so much. I guess my classmate (not known for tact) was really on her case. Anyway, this is her lipid panel:

Total: 204
LDL: 90
HDL: 101 (yes, you read that correctly and I did not get this backwards with LDL)
Trig: 57
Ratio: 2.0

I asked her what she ate for breakfast and she said "two eggs in butter with cheese and a couple ounces of orange juice to wash it down." Granted the OJ isn't ideal, especially for a diabetic, but for people struggling in Detroit, that is a better breakfast than I could ask for. So, when I saw this lipid result, I told her not to listen to the other student. I told her that she definitely needs to control her sugar, but her lipid panel is nothing to be concerned about. I praised her for the high HDL and explained how it is protective. The PA came in and told her to switch the 2 eggs to 1 egg and one white "to lower her cholesterol". CW says a diabetic's LDL needs to be less than 70. Still, I think she is doing well. What do you all think?

I just want to be sure I'm not way off base thinking this is a good result when it isn't. I personally haven't seen another person's HDL over 100 except in teenage athletes in the peds practice I was at.

[DFH]

Without looking up any references, CW or not, I would say those look OK. Low trigs and high HDL look good.

Find the other person that was angry at the patient and slap some sense into them.

Edit:
BTW, the eggs = cholesterol and cholesterol = bad thing is a lie, but you knew that.

[Heidi]

Hey, we're in the same area. Nice to 'meet' you!

That woman's HDL is awesome! I read that a women's HDL is the best indicator of how long she'll live (with higher = longer). Since her trigs are pretty low, I wouldn't be worried about the LDL. Did the test show which LDL particles she has more of? If it's the dense ones (if I recall correctly, they're the 'good' ones), then she has nothing to worry about. Besides, her LDL is still in the normal range.

[nolineon]

'please comment on this person's lipids'

Those are some NICE lipids!!!

[Dr. Bork Bork]

Ohmigosh, I would smack your classmate. I don't know a whole lot about lipids, but those look really healthy! I hope you hugged her.

[ShannonPA-S]

Ohmigosh, I would smack your classmate. I don't know a whole lot about lipids, but those look really healthy! I hope you hugged her.

Funny enough, I did hug her!!

[quelsen]

does a mans hdl matter?

[Barb]

Really, honestly - that is a GREAT lipid profile. For someone with diabetes who has recently been running some high blood sugars, those low trigs are FANTASTIC. (Trigs are raised with higher carb levels, and high trigs are more of a health risk for diabetics than LDL). Tell her to just keep up the good work. And tell that "other student" that her total cholesterol is over 200 because over HALF of it is HDL!

If the patient (or the other student) is really worried about her cardiovascular risk, then more labs need to be run to look at her level of inflammation (CRP and Homocysteine), her HA1C, LDL particle size, and what is her BP? If someone has low to normal BP, they aren't going to be sustaining much damage to their blood vessels. Inflammation + high blood pressure + high blood sugar + small density LDL = high risk for heart disease.

Here are some links to a couple of very helpful articles about cholesterol and heart disease. You might share them with the other student!

Debunking the cholesterol causes heart disease myth:
Why Cholesterol May Not Be the Cause Of Heart Disease

Article on importance of knowing LDL particle size:
http://www.centerforpreventivemedici..._messenger.pdf

Good thing your patient had you reviewing her labs this time!

[loafingcactus]

does a mans hdl matter?

Men's, slightly. Women's, no.

[quelsen]

i have raised mine from 34 to 40 but i dont know how

last years number are
total 146
hdl 34
ldl 105
trigs 47

this year isnt much different i know Ldl was 101 and HDL was 40 and total was 130 but cant remember trigs