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A Middle-Aged Man With Multiple Red Flags: How Would You Proceed?


A 47-year-old man sees you for a check-up. He complains only of low energy and attributes it to recent weight gain. But, there is much more.

Jose is 47-year-old Hispanic man who comes to your office for a “check up.” His only symptom is that he notices he does not have the energy he once had but thinks “it’s because of his weight.” He has worked at a desk for 3 years and has gained 12 pounds.

He has several paternal aunts and uncles with type 2 diabetes mellitus, and his father died at age 49 of an MI. His BMI is 29; blood pressure, 143/88 mm Hg; waist circumference, is 42 inches.

Lab values:

Fasting blood sugar: 132 mg/dL

HbA1c: 6.2%

Total cholesterol, 180 mg/dL; triglycerides, 250 mg/dL; LDL (calculated), 100 mg/dL; HDL, 30 mg/dL; non-HDL, 150 mg/dL

Do you consider an LDL level of 100 mg/dL and a non-HDL level of 150 mg/dL significant? What is your diagnosis? Would you consider medication in addition to recommending lifestyle changes?

Thank you for submitting your answers and comments. I invite you to read a summary discussion. . . please click here.

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