Case Study: Roy
Roy is a 65-year-old male with a medical history of asthma, hypertension, obesity and COPD.
He had been on multiple medications for the above conditions, including:
- Steroid inhalers
- Nebulizer treatments
- Multiple supplements
He returned to the clinic in January 2018 to follow up on his symptoms of shortness of breath and inability to exercise. He had been struggling for years with this condition.
I inquired about his cardiac health and past work up, which was unremarkable. He had mildly elevated lipids and blood pressure.
I recommended that he repeat CT calcium score imaging and get Lp(a) completed with his next set of lab work.
When he returned for his follow up appointment, his CT calcium score showed a total score of 504, which put the patient in the 77% percentile of asymptomatic males between 60-64.
He had extensive plaque and a high likelihood of at least one coronary artery narrowing. His lab work revealed that Lp(a) was 365 (the normal amount is < 74 nmol/L).
Urgently, he was referred to a cardiologist. He ended up having an angiogram (a procedure that uses x-rays to photograph blood vessels) and this showed he had 99% blockage in his right coronary artery.
As a result, Roy ended up needing a cardiac stent. Post-procedure, he was discharged with two blood thinners and statin prescriptions.
At our next follow up in June 2018, he had discontinued one blood thinner and statin medication. His blood work showed that Lp(a) had lowered to 265 and his LDL cholesterol was improved from 143 to 121.
Roy noted that he was able to walk briskly for 1.5 miles every day and that he did not need his inhalers. His asthma had improved and his oxygen count had finally increased from 92 to 98. He also reported that he had been tracking his blood pressure and it was normal.
Our treatment plan was to keep up with daily exercise, work with a nutritionist to help with weight loss and supplements to help him decrease lipids since he was unable to tolerate the statin. We will follow up with him in 90 days to check in on his progress.