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One-Month Follow-Up
After 1 month, WM’s fasting glucose has dropped to 123 mg/dL. You recheck his lipid profile and obtain an A1c level (Table 1).
Q: How would you characterize WM’s cardiovascular risk based on this lipid profile?
A: According to the American Diabetes Association, WM’s low HDL level places him in the high risk category (Table 2).2 In addition, according to the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III),3 diabetes is considered a CHD risk equivalent. That is, a person with diabetes is considered to have the same risk for a cardiovascular event as a person without diabetes who has already had an event. WM also has an LDL above 100 mg/dL.
WM displays a characteristic pattern of dyslipidemia found in many patients with type 2 diabetes—elevated triglyceride levels, high/normal LDL-C levels, and decreased HDL-C levels. LDL-C levels in patients with type 2 diabetes are usually not significantly different from those of nondiabetic individuals. However, these patients typically have a preponderance of smaller, denser LDL particles, which may increase atherogenicity even if the absolute concentration of LDL cholesterol is not significantly increased.
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