Rachel Stagg

PED 103-701
Critical Thinking Assignment
Understanding a Blood Lipid Panel
Total cholesterol: 249 mg/dl
Triglycerides: 89 mg/dl
HDL cholesterol: 61 mg/dl
VLDL cholesterol: 18 mg/dl
LDL cholesterol: 170 mg/dl
I. Understanding the Issue: Cholesterol is a steroid that is produced in the body and is
also consumed in many of the foods we eat. The liver produces enough cholesterol
that it is not necessary to consume any in our diet, but a certain amount of cholesterol
consumption is not unhealthy. Cholesterol circulates throughout the blood by protein
packages, or lipoproteins, that are manufactured by the body. These include very low-
density lipoproteins (VLDL), high-density lipoproteins (HDL) and low-density
lipoproteins (LDL). Cholesterol and triglycerides are packaged into VLDLs in the
liver and then sent through the bloodstream. VLDLs are then broken down into LDLs
(the primary transporters of cholesterol), which deliver cholesterol to the cells and are
then removed from the bloodstream. If LDLs are in excess in the body, then removal
from the blood becomes impossible because the liver and other areas with LDL
receptors become saturated. This is when people have an increased risk for heart
disease because an excess of LDL cholesterol can cause atherosclerosis in the
arteries. HDLs can reverse the effects of excess LDL cholesterol to a certain extent,
because they break down excess cholesterol and allow it to be removed by feces.
II. Identify the Problem, its Significance and its Supporting Evidence: The patient is
definitely at risk for many health diseases due to their high levels of total cholesterol
and LDL cholesterol. This patient, however, does have a fairly high, 61 mg/dl, level
of HDL cholesterol. High levels of HDL cholesterol, above 60mg/dl provide a lower
than average risk of heart disease, and can help to reverse the effects that LDL
cholesterols have. An elevated level of any of these components of the blood lipid
panel can cause concern for a patient. Elevated LDL levels are associated with
atherosclerosis, which is hardening of the arteries. This patient needs to attempt to
lower their levels of LDL cholesterol and total cholesterol. The acceptable ranges for
these cholesterols are:
i. Total cholesterol should be less than 200 mg/dl 249 puts this patient at
a higher risk for heart disease
ii. Triglycerides should be less than 150 mg/dl 89 mg/dl is an acceptable
level
iii. HDL cholesterol levels should be above 40 mg/dl, and 60 mg/dl is
excellent this patient has a very healthy level of HDLs
iv. VLDL cholesterol should be between 5-30 mg/dl this patient has a
healthy amount of triglycerides (Behrenbeck, 2012).
v. LDL cholesterol should be less than 100 mg/dl 170 mg/dl is not
acceptable, and puts this patient at risk for heart diseases
III. Assumptions: Based on this persons blood lipid panel results I would think that they
are:
a. I believe that this person is somewhere around middle-aged, because though they
have two areas of the blood lipid panel a little higher than normal, the other three
are in perfectly acceptable range. As we age, our bodies metabolisms slow down,
we lose some hormone production, and we are more at risk for heart diseases. I
think that since this patient has only two of the five out of range, and not too far
out of range at that, they must be experiencing some of these issues because they
are middle-aged. However, if they were even older, in the old-age category, I
think their cholesterol levels could be even more out of range, because age is one
of the unchangeable risk factors associated with heart disease.
b. Based on the questions that I received from the patient, my assumption is that this
patient is a middle-aged female. Originally, I would have assumed that this was a
middle-aged man, because men are more likely to showcase the risk factors for
cardiovascular disease earlier than women. But now that I have received answers
to my questions, I feel that is a middle-aged female.
c. I believe that perhaps this patient is African American. I say this because African
Americans are more likely to have hypertension, and the risk factors associated
with hypertension. This patient is likely hypertensive or will be in the future
because of the high levels of LDL cholesterol and total cholesterol. It is a
complete assumption, but it is possible that since this patient is a woman when I
initially thought it was a man, the increased levels of cholesterol could be due to
her race.
d. The patient is somewhat physically active, because the high levels of HDL
cholesterol indicate that the patient is not sedentary. Also, I believe that this
person does not smoke now, because smoking decreases the amount of HDL
cholesterol in the body.
e. Though I think this patient is most likely in an active job position, I think that
they are also possibly overweight. 66% of adults are classified as overweight.
Being overweight leads to higher intake of cholesterol, which can lead to many
other risk factors associated with heart diseases and atherosclerosis.
IV. Relevant Questions:
a. Do you have a family history of cardiovascular disease?
i. Not that I know of
b. What is your current physical activity level? Do you have a job that requires you
to be physically active?
i. I attend Zumba classes at least twice a week
ii. No, I have a desk job; I sit and stare at a computer for eight hours a day
c. What does your typical diet consist of?
i. I typically have a whole grain cereal, whole fruit and juice for breakfast;
lunch is usually yogurt, fruit and maybe a sandwich; dinner varies
depending on my schedule but it is usually some type of protein, a
vegetable and a starch. I avoid fast food as much as possible. I do have a
sweet tooth but I try not to over-indulge.
d. Do you or have you ever smoked? Do you drink excessive amounts of alcohol?
i. I smoked for a few years as a teenager
ii. No, but I do enjoy a glass or two of wine most nights of the week
e. What is your normal blood pressure?
i. 124/82
f. Do you have diabetes or a history of heart disease?
i. No
g. Do you handle stress well?
i. I think I do a pretty good job handling stress; that is what the wine,
friends, and Zumba class is for.
V. Conclusions and Recommendations:
a. If this were my patient, I would tell her that she is doing many things correctly
already. Her blood pressure could be lowered a small amount, and that would
reduce her risk for heart disease in the future. Lowering her blood pressure can be
done in a number of ways: losing a little weight, taking supplements like calcium,
magnesium, and potassium, and additional exercise to what she is doing now.
Zumba is a great choice for exercise, because it is fast-paced and gets the heart
rate elevated and keeps it elevated throughout the workout. But perhaps she could
add in a few days of brisk-paced walking with her friends, or by herself, to
supplement her twice weekly Zumba classes. She is already getting some
vigorous intensity workout with Zumba, but walking for about 30 minutes twice a
week, she could reduce her blood pressure, and also her LDL cholesterol. The
patient already eats a pretty healthy diet, having a sweet tooth is not a problem as
long as she keeps it in check, which she claims to. I think that overall this patient
is very healthy. Her age, and the fact that she could possibly have gone through or
be going through menopause can also contribute to the higher levels of
cholesterol, and increased weight because of a slowing metabolism. If this is the
case she can take hormone supplements that can possibly lower her LDL
cholesterol and her risk for cardiovascular disease. Overall, she is pretty healthy,
but she can still take some preventative measures now so that her risk for
cardiovascular disease is decreased.

References
American Association for Clinical Chemistry. (2013, February 14). Lipid Profile. Retrieved from
http://labtestsonline.org/understanding/analytes/lipid/tab/test
Anspaugh, D. J., Hamrick, M. H., & Rosato, F. D. (2011). Wellness: Concepts and applications
(8th ed.). New York: McGraw-Hill Higher Education.
Behrenbeck, T., M.D. (2012, June 22). What is VLDL cholesterol? Retrieved from
http://www.mayoclinic.com/health/vldl-cholesterol/AN01335