Case Study 3:
A 50-year old female with low CVD risk, primary prevention

Case Study 3: A 50-year old female patient in good health and with normal body weight. Not taking any medication.

She is around the age of menopause and at a check-up it was discovered that she has elevated total cholesterol (7.2 mmol/L or 280 mg/dL). She reports recent tireless and moderate hair loss.

Cardiovascular disease risk factors identified:
  • Hypercholesterolaemia: Serum total cholesterol 280 mg/dL (7.2 mmol/L), elevated, LDL-cholesterol 186 mg/dL (4.8 mmol/L, elevated, HDL-cholesterol 70 mg/dL (1.80 mmol/L)
  • Age: 50 years
  • Non-smoker
  • No family history of CVD
  • BMI: 23 kg/m2
  • Moderate physical activity
  • Blood pressure: 125/80 mg Hg
  • Blood glucose: 5.3 mmol/L (96 mg/dL)
  • CVD risk Score: low risk


  • According to the EAS/ESC guidelines for the management of dyslipidaemia, lifestyle advice and intervention, followed by considering adding a drug if serum cholesterol remains uncontrolled should be initiated
  • LDL-cholesterol lowering represents the primary target for lifestyle intervention
  • The recommended diet focusses on reduced intake of saturated and trans fats, an increased intake of dietary fibres and using foods with added phytosterols (plant sterols/stanols)

As sub-clinical hypothyroidism is common for females around the menopause, and in this case elevated cholesterol and same signs of hypothyroidism (hair loss, asthenia) thyroid function should be checked. Thyroid stimulating hormone (TSH) was normal).

  • Advice was given to the patient about eating a heart healthy diet and regular physical activity

Follow up after 12 months.

  • There was no change in body weight and blood pressure (120/80 mgHg)
  • Diet evaluation revealed a reduction in the intake of saturated fats
  • Serum cholesterol was lowered (total cholesterol 263 mg/dL (6.8 mmol/L), elevated, LDL-cholesterol 170 mg/dL (4.4 mmol/L, elevated, HDL-cholesterol 70 mg/dL (1.80 mmol/L)
  • But, according to the guidelines, LDL-cholesterol should be <116 mg/dL (3.0 mmol/L); hence, further reduction in LDL-cholesterol is desirable
  • The patient was reluctant to take a lipid lowering drug (statin). Subsequently, a coronary artery calcium (CAC) score was undertaken which showed a score of 0
  • Advice was given to further step-up diet and lifestyle intervention; regarding diet, the intake of dietary fibre should be increased and foods with added phytosterols should be consumed
  • If the LDL-cholesterol goal is then still not reached, pharmacological therapy, e.g., statin treatment (starting with a low dose) should be initiated next to continuing with diet and lifestyle intervention