1. Lipids & Lipoproteins
Part 2

2. M. Zaharna Clin. Chem. 2015

3. M. Zaharna Clin. Chem. 2015

4. Cardiac enzyme CK and CK isoenzyme and LD and LD isoenzyme would be useful.
Fasting total cholesterol, triglycerides, and HDL and LDL cholesterol could also be performed, but the values should be interpreted with caution because the patient is under stress and may have suffered a MI.
The fasting lipids should be repeated after he has been released from the hospital. If he had a MI, it will be approximately 6 weeks before the values represent true levels.
M. Zaharna Clin. Chem. 2015

5. With a total cholesterol level of approximately 280 mg/dL and normal triglycerides and HDL cholesterol, his LDL cholesterol is estimated to be >190 mg/dL, which is extremely elevated.
His physician presumably would have started him on a Step II diet prior to leaving the hospital, based on the in-hospital values.
If the 6- to 8-week values do not show significant improvement, the physician would probably start him on medication.
The patient has a family history of CHD, and, presumably, the patient has now been diagnosed with CHD. Therefore, the goal would be to reduce LDL cholesterol values to <100 mg/dL.
Step 2 diet (30% of calories or less as total fat, less than 7% saturated fat, and less than 200 mg cholesterol per day) 
M. Zaharna Clin. Chem. 2015

6. M. Zaharna Clin. Chem. 2015

7. Eruptive xanthomas; triglycerides
Yes
Yes, she has diabetes mellitus.
Cessation of estrogen replacement therapy, with consideration of transdermal estrogen therapy, triglyceride- lowering diet and medication, hypoglycemic medication. Most acute risk is pancreatitis.
M. Zaharna Clin. Chem. 2015