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What is the cause of my vascular problems?

Q: I am 41 years old. I weigh around 85 kg and I am 5.7 inches tall. My lipid profile is as follows: Cholesterol: 215 mg/dl; HDL: 32 mg/dl; LDL: 94.4 mg/dl; Triglycerides: 443 mg/dl; Blood Sugar F: 77 mg/dl, PP: 111 mg/dl; ECG: WNL; TMT: no exercise induced ischemia (up to 9 min); X-ray Chest: Normal; T3, T4, TSH: WNL and BP: 118/74 mmHg. I smoke around 4-5 cigarettes a day and consume non-vegetarian and liquor very occasionally, about once a month. My diet is quite moderate in spite of my weight, it is light breakfast, 2 chappatis with vegetable and dal, both in lunch and dinner, no in between snacks. I have a fleeting pain on the left side of my chest, at times on right side and more around the left shoulder, which keeps on changing its location and is constant with no relation to movement. It starts spontaneously even during rest. It doesn't get relived by pain killers. I tried sorbitate but got no relief. I have a problem of GERD and at times get sinus tachycardia. I am taking Fenofibrate for my elevated triglycerides and Aten 12.5 mg for my sinus tachycardia. What is the reason for the pain? Are my triglycerides too high and is there any cause of worry? Can I develop blockage of arteries? I have no chest pain or heaviness on walking long distances but the discomfort in the right shoulder area stays constant for days. Please suggest something.

A:Your clinical data suggests that you have elevated triglycerides associated with low HDL cholesterol and your body mass index (BMI) is high. This combination is seen often in south Asian population. The discomfort you get does not seem to be related to an heart disease. It is good that your BP and blood sugar levels are fine. Often individuals with your kind of lipid profile and body habits is associated with impaired glucose tolerance and elevated BP. This combination then becomes much more prone to develop vascular events. I think you should become physically more active with a regular exercise programme and a diet which avoids refined carbohydrates and low in saturated fats. Coarse cereals, fruits ad vegetables are good. Fenofibrates are good for reducing triglycerides and increasing HDL cholesterol. Recheck the lipid profile after a few months. The target of triglycerides is around 150 or lower. Cigarette smoking is bad even if you take less than 10/day. You should give up tobacco use. Alcohol in moderation is OK and reduces vascular events. Yearly check up including a TMT is helpful in detecting problems early.

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