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Patient Case Study
submitted by Michael E. Cobble, MD, AAFP, FNLA Your Patient’s Lipids are at Goal and Their Diabetes is in Control: Is That Good Enough?
Michael Cobble, MD, AAFP, FNLA, a Board Certified Lipidologist and Director of Canyons Medical Center in Sandy, Utah, routinely counsels patients on their heart health and is a member of numerous organizations whose goals are to improve cardiovascular care. The following case study reviews the medical history of one of his patients whose hidden risk for heart attack and stroke was uncovered with the PLAC® Test for Lp-PLA2.
“Use of the PLAC® Test in ‘moderate risk’ patients, as classified by traditional risk factors, helps me uncover hidden risk in patients who may need more scrutiny, and therefore, more effectively risk stratify and treat to improve their health and prevent cardiac events.” Exam and Labs Tests:
ƒ Body Mass Index (BMI): 30, Waist < 40 inches ƒ He is doing very well with good control of his blood pressure, asthma, acid ƒ HbA1c is down from 7.2% to 6.1% on Metformin (tid) over last 2 years ƒ Thyroid and Complete Metabolic Panel (CMP) normal ƒ Standard Lipid Panel normal (TC, TG, LDLc, HDLc) Background, Family and Social History:
Normal Range*
ƒ Mother with heart disease and hypertension Medications:
ƒ Prevacid® (Lansoprazole) 30 mg, Vitamin D (OTC), testosterone, ProAir® HFA (albuterol sulfate), Symbicort® (budesonide/formoterol fumarate dihydrate), metformin 500 mg three times a day, lisinopril 20 mg, aspirin 81 mg, simvastatin 20 mg For more information please visit www.plactest.com
* Ranges can vary based upon lab performing testing and the or call 1.877.752.2837
specific patient based upon certain risk stratification. Rationale:
Take Home Message:
I started testing Lp-PLA2 levels even in these cases where it seemed ƒ In this case of a well controlled patient with diabetes the glucose was under control and the blood pressure and lipids were and hypertension, Dr. Cobble chose lab testing before responding. Here the results indicate we still had some residual risk imaging and utilized the VAP® Test Panel including with vascular inflammation. Due to the elevation of this risk marker we the PLAC Test for Lp-PLA2 to guide his treatment decided to target LDLc more aggressively with combination therapy including niacin with statin (Simcor® 1000/20 at bedtime or dinner). In ƒ Abnormal values led Dr. Cobble to request imaging this case, his direct LDLc was at goal, his non-HDLc and ApoB and HDLc where he was able to further assess the disease using were all very good. However, his elevated Lp-PLA2 motivated me to
perform simple, noninvasive imaging which showed plaque presence:
ƒ Lp-PLA2 testing can have great utility in the ƒ Carotid Ultrasound/Carotid Intimal Medial Thickness (CUS/CIMT) personalized approach to preventive cardiovascular medicine. A more potent statin or combination lipid modifying therapy may potentially achieve a greater y Multiple areas of plaque were seen – the largest was on the reduction in cardiovascular inflammation, and the right at 3.4 mm (heterogeneous) and 1.8 mm on the left
PLAC Test uncovered that option. It’s a simple, non- J.R. was switched to Simcor® (niacin and simvastatin) 1000/20 mg fasting blood test, which is easily accessible and affordable.
Follow-up Exam:
Repeat lab testing February 1, 2010 a year later revealed:
Michael E. Cobble, MD, AAFP, FNLA
Director/Clinician Canyons Medical Center, Sandy, UT
Normal Range*
Adjunct Faculty Univ. of UT School of Medicine, Board Certified Clinical Lipidologist (NLA) Michael E. Cobble, MD, is Director of Canyons Medical Center in Sandy, Utah where he has been in private practice for 16 years. He is also an adjunct faculty member of the University of Utah School of Medicine. Dr. Cobble is CME Director for and serves on the Board of Directors of the Utah Healthy Living Foundation. Dr. Cobble is a member of numerous professional organizations including the American Academy of Family Physicians, the American Academy of Physician Assistants, the American Heart Association, and the American Stroke Association, Leadership Council for Improving Cardiovascular Care as well as the Society of Atherosclerosis and Imaging Prevention.
He has a passion for treating diabetes, heart disease, bipolar disorder and the full spectrum of medicine in both children and adults. He enjoys teaching his patients and other clinical providers.
The PLAC® Test for Lp-PLA2 is the only FDA-cleared blood test that helps identify hidden risk for both heart attack and stroke. The PLAC Test is recognized in four major clinical practice guidelines recognizing its significant value. LDL modifying medications can lower Lp-PLA2; in some combinations of modifying medications the remarkable reduction can be up to 50%. Early detection and more aggressive treatment can help prevent cardiovascular events.
For more information please visit www.plactest.com
or call 1.877.752.2837
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