Low Density Lipoprotein Post Menopausal Woman Discussion A generally healthy 59-year old post-menopausal woman has had incrementally increasing LDL levels

Low Density Lipoprotein Post Menopausal Woman Discussion A generally healthy 59-year old post-menopausal woman has had incrementally increasing LDL levels in blood test results over the past few years. You had warned her of the need to get this under control as she had been on HRT for severe vasomotor complications during menopause which could have increased her overall risk for cardiovascular complications. At her last visit, you recommended diet changes and increased exercise as a means to naturally bring her hyperlipidemia under control. Being a diligent patient, she has made these changes, e.g., cutting back to 1% milk and increasing the length of her evening walk. But today, with her LDL still high, you have suggested she add a low-dose statin. She accepts your recommendation, puts the prescription in her pocketbook but just before leaving, she says “what about avocados?” She goes on to say that she was at a Mexican restaurant recently and overheard a group of women at the table behind her talking about cholesterol. One of the women said “I saw on the Internet that avocado can help lower cholesterol so I am going to eat a lot more guacamole!” Your patients asks “is this for real?”

Is there any indication that avocado can be effective for lowering cholesterol? What, if any, is the strength of evidence supporting this?

Are there any diagnostic studies that should be ordered on this patient? Why?
List three differential diagnoses for this patient. Explain your reasoning for each.
Discuss your management plan for this patient, including patient education, referrals, and follow-ups.

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