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HIPERLIPIDEMIA
SINTESIS
KOLESTEROL
Case 1
T.A., a 43-year-old premenopausal woman, is screened with a lipid profile during an annual
medical evaluation. She has never taken cholesterol-lowering medication and currently takes
only a multivitamin daily. She has had no symptoms of coronary, carotid, or peripheral vascular
disease. She has a 20–pack-year history of smoking and exercises four times a week, without
physical limitations. T.A. states that she follows a low-fat, low-cholesterol diet. Her father is
alive and well at age 71, with a normal cholesterol level. Her mother had an MI at age 47 and
died at age 57 from a second event. Her grandfather died of an MI at age 52; a sister has
hypercholesterolemia and is taking simvastatin. Pertinent physical findings are weight, 125
pounds; height, 63 inches; blood pressure (BP), 120/82 mm Hg; pulse, 66 beats/minute and
regular; carotid pulses symmetric bilaterally without bruits; no neck masses; no abdominal
bruit; and no evidence of tendon xanthomas.
Pertinent laboratory findings, obtained after a 12-hour fast,
show the following results: Total cholesterol, 290 mg/dL ; TG,
55 mg/dL ; HDL-C, 55 mg/dL ; LDL-C, 224 mg/dL ; Non–HDL-
C, 235 mg/dL ; Plasma glucose, 96 mg/dL ; Thyroid-stimulating
hormone (TSH), 0.92 international units/mL ; Alanine
aminotransferase (ALT), 11 units/L ; Aspartate
aminotransferase (AST), 8 units/L ; Blood urea nitrogen, 12
mg/dL ; Creatinine, 1.0 mg/dL ; Urinalysis, negative
Case 2
D.E. is a 45-year-old man with no evidence of CHD. His
father and grandfather both died suddenly of apparent heart
attacks in their early 50s, but D.E. has no other CHD risk
factors. He has no evidence of secondary causes of
dyslipidemia. On physical examination, he is noted to have
bilateral corneal arcus and bilateral Achilles’ tendon
xanthomas; the rest of his examination findings are normal.
Likewise, his laboratory test results are within normal limits,
except for the following lipid profile:
• Total cholesterol, 440 mg/dL
• TG, 55 mg/dL
• HDL-C, 55 mg/dL
• LDL-C, 374 mg/dL
Case 3
B.C., a 56-year-old man, experienced acute chest pain 3
months ago and was admitted to the local hospital with a
diagnosis of unstable angina. His only known medical problem
was hypertension treated with enalapril 10 mg every day. His
lipid profile on admission was as follows:
• Total cholesterol, 235 mg/dL
• HDL-C, 30 mg/dL
• LDL-C, 165 mg/dL
• TG, 300 mg/dL
He underwent a cardiac catheterization, which revealed a 90%
stenotic lesion in his left anterior ascending artery. A drug-
eluting stent was placed without difficulty. He was
subsequently discharged on simvastatin 40 mg every evening
at bedtime, ezetimibe 10 mg every day, acetylsalicylic acid
325 mg every day, clopidogrel 75 mg every day, metoprolol 100 mg
twice daily, and enalapril 10 mg every day. Today, he weighs 220
pounds, is 6 feet tall (ideal body weight, 140 to 185 pounds), and has a
waist circumference of 42 inches. He has lost 10 pounds since his
diagnosis of unstable angina by following a low-fat diet and an exercise
program. He swims 1 mile three times a week without symptoms of
cardiac ischemia, and he drinks two glasses of wine each evening with
dinner. His father died at age 58 of an MI (lipids unknown). He has
never smoked. Pertinent physical findings include a BP of 148/90 mm
Hg, heart rate that is 60 beats/minute and regular, arcus senilis, carotid
pulses equal without bruits, and chest clear to auscultation without
cardiomegaly. Laboratory tests disclose normal TSH levels, normal
renal and liver function, and a fasting glucose level of 120 mg/dL. His
urinalysis was normal. The lipid profile while taking the above regimen
is as follows:
• Total cholesterol, 143 mg/dL
• TG, 210 mg/dL
• HDL-C, 33 mg/dL
PERTANYAAN
• Apa saja tanda, gejala, dan
pemeriksaan laboratorium yang
penting utk diagnosis pada pasien?
• Bagaimana pemilihan obat Utk
pasien?
• Apakah ada keadaan tertentu pada
pasien yang dapat mempengaruhi
farmakoterapinya?
• Apakah ada interaksi obat-obat,
kontraindikasi, atau efek samping
yang terjadi pada pasien?