Assessing Cardiovascular Risk in a 42-Year-Old Patient with Abnormal Lab Results
According to the lab test results and patient data available, this patient has several risk factors for cardiovascular disease (CVD). Frames of hypertriglyceridemia, high LDL cholesterol, low HDL cholesterol, and controlled diabetes with increased HgBA1c tell of significant chances of developing CVD. Notably, these risks become overwhelming, thus compounding the complexity (Khanali et al., 2023). As a Family Nurse Practitioner (FNP), the clinical management and follow-up will emphasize the utilization of both pharmacological and non-pharmacological interventions to lower the CVD risk and, ultimately, improve health outcomes (Khardori, 2019).
Pharmacological Interventions
- Statin treatment decreases LDL cholesterol levels in the blood and prevents the development of atherosclerosis or its progression.
Common statin medications include atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor).
Typical starting doses:
Atorvastatin: 10-20 mg once daily
Rosuvastatin: 5-10 mg once daily
Simvastatin: 20-40 mg once daily
- Anti-hypertensive medications for blood pressure regulation within the set target (the usual <130/80 mmHg for diabetes patients).
Common classes of antihypertensive medications include ACE inhibitors, angiotensin II receptor blockers (ARBs), beta-blockers, calcium channel blockers, and diuretics.
Example medications and typical dosages:
ACE inhibitors (e.g., lisinopril): Starting dose of 10 mg once daily, titrated up to 20-40 mg once daily as needed.ARBs (e.g., losartan): Starting dose of 50 mg once daily, titrated up to 100 mg once daily as needed.Beta-blockers (e.g., metoprolol): Starting dose of 25-50 mg once daily, titrated up to 100-200 mg once daily as needed. Calcium channel blockers (e.g., amlodipine): Starting dose of 5 mg once daily, titrated up to 5-10 mg once daily as needed.Diuretics (e.g., hydrochlorothiazide): Starting dose of 12.5-25 mg once daily, titrated up to 25-50 mg once daily as needed.
- Antidiabetic medicines or insulin injections for the regulation of blood glucose levels and lowering HBA1c values.
Metformin: Starting dose of 500 mg once or twice daily, titrated up to 1000-2000 mg once or twice daily as tolerated.
Sulfonylureas (e.g., glipizide): Starting dose of 5 mg once daily, titrated up to 5-20 mg once daily as needed.
Insulin (e.g., basal insulin such as insulin glargine or insulin detemir): Starting dose based on individual patient requirements, typically initiated at 0.2-0.4 units/kg/day and adjusted based on blood glucose monitoring.
Non-Pharmacological Interventions
- Smoking cessation counseling and support to lower cardiovascular risks that come as a result of smoking.
- Inclusion of diets low in saturated fats and cholesterol and high in fruits, vegetables, whole grains, and lean proteins.
- Regular aerobic activities at a moderate activity level, for at least 150 minutes per week, are tailor-made to each patient’s skills and hobbies.
- Weight reduction methods are meant for the balance of body weight and preventing obesity-related complications including insulin resistance and dyslipidemia.
- Education and constant monitoring of blood glucose levels and strict adherence to taking medications and living a healthy lifestyle.
Notably, a Family Nurse Practitioner (FNP) will organize routine follow-up visits to track the patient’s progress, fine-tune medications wherever appropriate, and continue training and support. As such, the FNP will work in conjunction with other healthcare professionals, Joseph et al., (2022)., including nutritionists and diabetes educators, to ensure that the patient gets quality care and the best results in the long term.
References
Joseph, J. J., Deedwania, P., Acharya, T., Aguilar, D., Bhatt, D. L., Chyun, D. A., Di Palo, K. E., Golden, S. H., & Sperling, L. S. (2022). Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes: A Scientific Statement From the American Heart Association. Circulation, 145(9). https://doi.org/10.1161/cir.0000000000001040
Khanali, J., Ghasemi, E., Rashidi, M.-M., Ahmadi, N., Ghamari, S.-H., Azangou-Khyavy, M., Malekpour, M.-R., Abbasi-Kangevari, M., Hashemi, S. M., Naderian, M., Rezaei, N., Dilmaghani-Marand, A., Farzi, Y., Kazemi, A., Yoosefi, M., Hajebi, A., Rezaei, S., Azadnajafabad, S., Fattahi, N., & Nasserinejad, M. (2023). Prevalence of plasma lipid abnormalities and associated risk factors among Iranian adults based on the findings from STEPs survey 2021. Scientific Reports, 13(1), 15499. https://doi.org/10.1038/s41598-023-42341-5
Khardori, R. (2019, June 18). Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia. Medscape.com. https://emedicine.medscape.com/article/117853-treatment
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Question 
The 42-year-old female patient presents for a follow-up on lab results from her annual physical exam completed a week ago. The lab results are as follows: Triglycerides 225, LDL 170, HDL 22, HgBA1c 8.3%. The vital signs are as follows: BP – 148/92, HR – 76, RR – 18, Tempe – 97.2.
Assessing Cardiovascular Risk in a 42-Year-Old Patient with Abnormal Lab Results
Patient history reveals a 20-pack-a-year smoking history and type 2 diabetes. The last labs done 18 months ago were normal. What is this patient’s cardiovascular risk based on these lab results? Describe how the FNP would clinically manage and follow up on this patient. List the pharmacological and non-pharmacological interventions.
Length: A minimum of 250 words, not including references
Citations: At least one high-level scholarly reference in APA from within the last 5 years