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Hyperlipidemia Clinical Trials Agenda LDL 248 Cholesterol VA Schedul
5003 -
5003 - ..
5004 - Summary/Objective
5005 -
500501 - Follow up ref SDS 6 YT4N, ref SDS 5 0000.
500502 -
500503 - Several articles purblished today by New York Times on changes in
500504 - health care standards for cardiology that increase cholesterol targets
500505 - from 70 to LDL 190, ref SDS 0 CW6H, and further cite clinical studies
500506 - showing statin medications reduce cardiovascular risks without
500507 - lowering cholesterol. ref SDS 0 HK9O Another article claims high
500508 - cholesterol maintains good health, for example sexual function which
500509 - is suppressed by statin drugs. ref SDS 0 KH4N Cholesterol aids
500510 - digestion, ref SDS 0 ME3G, memory and cognition, and the immune
500511 - system. ref SDS 0 9K6K The author says cardiovascular health requires
500512 - treatment for inflammation, infections, oxidation, glycation, stress.
500513 - ref SDS 0 KP6H Provides agenda issues for considering clinical trial
500514 - to reduce cholesterol. ref SDS 0 HP7I Letter to Kathy submits this
500515 - record and requests ideas for meeting with VA next week. ref SDS 0
500516 - U63F
500517 -
500518 -
500519 -
500520 -
500522 - ..
5006 -
5007 -
5008 - Progress
5010 - ..
501001 - New Directions Reducing Risks CAD
501002 -
501003 - Scheduled to meet with VA on 131121 to review clinical trials for
501004 - lowering cholesterol, and particularly LDL 249 to below 70, planned in
501005 - meeting at VA in Martinez with Doctor Egan on 131017 1000. ref SDS 5
501006 - 8B3M VA Progress Notes show referral made. ref SDS 5 EU9F
501008 - ..
501009 - Evidently, the American Heart Association published four (4) reports,
501010 - cited in the 3rd article, ref SDS 0 KL90, listing...
501011 -
501012 - 1. Cholesterol
501013 - 2. Overweight and obese patients
501014 - 3. Assessing cardiovascular risk
501015 - 4. Heart disease prevention through healthy lifestyle
501017 - ..
501018 - None of these reports is cited, so the precise language cannot be
501019 - reviewed, and nothing is quoted directly from the reports.
501021 - ..
501022 - The authors of published articles indicate the new standard is LDL
501023 - 190, article 1, ref SDS 0 HT87, and article 2, ref SDS 0 HV63, which
501024 - is still much lower than current LDL 249 reported in the lab on 131015
501025 - 0724. ref SDS 3 IM9N
501027 - ..
501028 - The goal for treatment is no longer to reach LDL 70, planned by the VA
501029 - in the record on 110309 0900, ref SDS 2 ZM98, but merely to take statin
501030 - medication for patients at risk of coronary artery disease, based on a
501031 - new 5-step composite process that includes blood pressure. ref SDS 0
501032 - HT80 One factor for taking statins is having a heart attack.
501033 - ref SDS 0 HT87
501035 - ..
501036 - These articles published today cite new AHA guidelines which allegedly
501037 - reference studies that show some statin medications reduce incidence
501038 - of cardiovascular maladies, regardless of whether cholesterol is
501039 - reduced. ref SDS 0 HV61 The graveman of the new guidelines seems to
501040 - be patients diagnosed at risk, such as those treated with CABG
501041 - surgery, in this case on 091022 0700, ref SDS 1 PQWU, should take
501042 - statins, without any understanding nor explanation of how this lowers
501043 - the risk of relapse and death, except for studies performed on
501044 - patients without regard to correlation to patient profiles.
501046 - ..
501047 - Fourth article not published by NYT, criticizes the new AHA guidelines
501048 - published yesterday on 131111, and claims treatments with statins to
501049 - lower cholesterol fails to reduce cardiovascular risks, that
501050 - cholesterol is vital to human health, ref SDS 0 KH4N, including LDL
501051 - that provides critical support for the immune system. ref SDS 0 9K6K
501052 - This position may align with new AHA guidelines increasing LDL level
501053 - from 70 to 190. ref SDS 0 HT87 The author of the fourth article says
501054 - cardiovascular risk can be reduced by treating...
501055 -
501056 - inflammation
501057 - infections
501058 - oxidation
501059 - glycation
501060 - stress
501062 - ..
501063 - The author of this article does not present treatments, nor explain
501064 - how taking statins reduces cardiovascular risks, as stated in AHA
501065 - guidelines, reported by the other authors. ref SDS 0 HV61
501067 - ..
501068 - New "risk assessment calculation" is mentioned several times in all
501069 - three NTY articles - article 1, ref SDS 0 HT80, and ref SDS 0 HT96,
501070 - and article 2, ref SDS 0 HV63, citing calculator, ref SDS 0 HV89,
501072 - ..
501073 - Interestingly, these risk calculators do not use LDL as a factor.
501074 - They make total cholesterol the biggest factor. ref SDS 0 UA64
501076 - ..
501077 - Weight loss is listed for lowering risk of heart attack. ref SDS 0
501078 - HT61
501080 - ..
501081 - Diet and exercise are presented as primary factors for avoiding
501082 - cornary artery disease, shown in article 1, ref SDS 0 HT61, article 3.
501083 - ref SDS 0 PJ7K
501085 - ..
501086 - How to balance lowering cholesterol to reduce cardiovascular risks,
501087 - while maintaining benefits of cholesterol. ref SDS 0 HC5L
501089 - ..
501090 - This provides agenda for meeting at VA SF Medical Center on 131121
501091 - 1000, scheduled on 131103 1739. ref SDS 6 Q27G
501092 -
501093 -
501094 -
501095 - 1. New York Times
501097 - ..
501098 - New Guidelines Redefine Use of Statins
501099 - By GINA KOLATA
501101 - ..
501102 - Published: November 12, 2013
501103 -
501104 - http://www.nytimes.com/2013/11/13/health/new-guidelines-redefine-use-of-statins.html?hp&_r=0
501106 - ..
501107 - 2. The nation's leading heart organizations, the American Heart
501108 - Association and the American College of Cardiology, released
501109 - new guidelines Tuesday that will fundamentally reshape the use
501110 - of cholesterol-lowering statin medicines that are now
501111 - prescribed for a quarter of Americans over 40. Patients on
501112 - statins will no longer need to lower their cholesterol levels
501113 - to specific numerical targets monitored by regular blood tests,
501114 - as has been recommended for decades. Simply taking the right
501115 - dose of a statin will be sufficient, the guidelines say.
501117 - ..
501118 - What is the title of the report, and where can it be reviewed?
501120 - ..
501121 - Article "New Guidelines Redefine Use of Statins" continues...
501122 -
501123 - 3. The new guidelines, based on a four-year review of the
501124 - evidence, also simplify the current complex, five-step process
501125 - for evaluating who needs to take statins. In a significant
501126 - departure, the new method also counts strokes as well as heart
501127 - attacks in its risk calculations, a step that will likely make
501128 - more people candidates for the drugs.
501130 - ..
501131 - 4. The new approach divides people needing treatment into two
501132 - broad risk categoriess. Those at risk because, for example,
501133 - they have diabetes or have had a heart attack should take a
501134 - statin except in rare cases. People with extremely high levels
501135 - of the harmful cholesterol known as LDL - 190 or higher should
501136 - also be prescribed statins. In the past, people in these
501137 - categories would have been put on statins, but they also would
501138 - have been told to get their LDL to 70, something no longer
501139 - required.
501141 - ..
501142 - 5. Everyone else should be considered for a statin if their risk
501143 - of a heart attack or stroke in the next 10 years is at least
501144 - 7.5 percent. Doctors are advised to use a new risk calculator
501145 - that factors in a persons blood pressure, age and total
501146 - cholesterol levels among other things.
501148 - ..
501149 - 6. It is not clear whether more or fewer people will end up taking
501150 - the drugs under the new guidelines, experts said. Many women
501151 - and African-Americans, who have a higher-than-average stroke
501152 - risk, might find themselves candidates for treatment, but
501153 - others taking statins only to lower LDL cholesterol to target
501154 - levels might no longer need them.
501156 - ..
501157 - 7. "Now one in four Americans over 40 will be saying, 'Should I be
501158 - taking this any more?'" said Dr Harlan M Krumholz, a
501159 - cardiologist and professor of medicine at Yale who was not on
501160 - the guidelines committee.
501162 - ..
501163 - 8. The previous guidelines put such a strong emphasis on lowering
501164 - cholesterol levels by specific amounts that patients who did
501165 - not hit their target levels just by taking statins often were
501166 - prescribed additional drugs like Zetia. But the new guidelines
501167 - say doctors should no longer prescribe those extra medicines
501168 - because they have never been shown to prevent heart attacks or
501169 - strokes.
501171 - ..
501172 - 9. The guidelines are part of a package of recommendations to
501173 - reduce the risk of heart attacks and strokes that includes
501174 - weight loss, lifestyle changes like moderate exercise, and a
501175 - healthy diet. But its advice on cholesterol is the flash
501176 - point, arousing the ire of critics who say the authors ignored
501177 - evidence that did not come from gold-standard clinical trials
501178 - and should also have counted less rigorous, but compelling
501179 - data.
501181 - ..
501182 - 10. Critics also question the use of a 10-year risk of a heart
501183 - attack or stroke as the measure for determining who should be
501184 - treated. Many people will have a lower risk simply because
501185 - they are younger, yet could benefit from decades of taking
501186 - statins that kept their cholesterol levels low, they say.
501188 - ..
501189 - 11. Dr Daniel J Rader, the director of the preventive
501190 - cardiovascular medicine and lipid clinic at the University of
501191 - Pennsylvania, points to studies of people with genes giving
501192 - them low LDL levels over a lifetime, saying that their heart
501193 - attack rate is greatly reduced.
501195 - ..
501196 - 12. He and other experts also worry that without the goad of target
501197 - numbers patients and their doctors will lose motivation to
501198 - control cholesterol levels.
501200 - ..
501201 - 13. Experts say it is still unclear how much the new guidelines
501202 - will change clinical practice. Dr Rader suspects that many
501203 - cardiologists will still strive for the old LDL target, at
501204 - least for patients with heart disease who are at high risk.
501205 - "They are used to it and believe in it," he said.
501207 - ..
501208 - Doctor Egan seems to support old medical practice of targeting
501209 - patient to lowere LDL below 70, reported on
501211 - ..
501212 - Article "New Guidelines Redefine Use of Statins" continues...
501213 -
501214 - 14. Dr Steven Nissen, a cardiologist at the Cleveland Clinic, said
501215 - he thought it would take several years for doctors to change
501216 - their practices.
501218 - ..
501219 - 15. The process of developing the new guidelines was rocky, taking
501220 - at least twice as long as previous efforts. The National
501221 - Heart, Lung, and Blood Institute dropped out, declaring that
501222 - drafting the guidelines was no longer part of its mission.
501223 - Several committee members, including Dr Rader, also dropped
501224 - out, unhappy with the direction the committee was going.
501226 - ..
501227 - 16. The architects of the guidelines say their recommendations are
501228 - based on the best available evidence. Large clinical trials
501229 - have consistently shown that statins reduce the risk of heart
501230 - attacks and strokes, but the committee concluded that there is
501231 - no evidence that hitting specific cholesterol targets made a
501232 - difference. No one has ever asked in a rigorous study if a
501233 - person's risk is lower with an LDL of 70 than 90 or 100, for
501234 - example.
501236 - ..
501237 - How was LDL 190 established, reported in para 4 above? ref SDS 0 HT87
501239 - ..
501240 - This new standard simiply says take medication because it reduces
501241 - heart attacks, but we don't know why? Does it mean that LDL below 190
501242 - does not require medication?
501244 - ..
501245 - Do statins reduce risk of coronary disease for causes other than high
501246 - cholesterol? If so, what does the medication do?
501248 - ..
501249 - Article "New Guidelines Redefine Use of Statins" continues...
501250 -
501251 - 17. Dr Stone said he was surprised by what the group discovered as
501252 - it delved into the evidence.
501253 -
501254 - 18. "We deliberated for several years," Dr. Stone said, "and could
501255 - not come up with solid evidence for targets."
501257 - ..
501258 - 19. Dr Nissen, who was not a member of the committee, agreed. "The
501259 - science was never there" for the LDL targets, he said. Past
501260 - committees "made them up out of thin air," he added.
501262 - ..
501263 - How was new target for LDL 190, in para 4, above, ref SDS 0 HT87,
501264 - established?
501266 - ..
501267 - Article "New Guidelines Redefine Use of Statins" continues...
501268 -
501269 - 20. The Department of Veterans Affairs conducted its own
501270 - independent review and came to the same conclusion. About a
501271 - year ago, the department, the nation's largest integrated
501272 - health care system, dropped its LDL targets, said Dr John
501273 - Rumsfeld, the VA's national director of cardiology.
501275 - ..
501276 - 21. "It is a shift," he acknowledged, "but I would argue that it is
501277 - not a radical change but is a course correction."
501279 - ..
501280 - 22. The department had used target LDL numbers as rewards for
501281 - doctors and hospitals.
501282 -
501283 - 23. "We got rid of that," Dr. Rumsfeld said.
501285 - ..
501286 - Doctor Egan seems to support old medical practice of targeting
501287 - patient to lowere LDL below 70, reported on
501289 - ..
501290 - Article "New Guidelines Redefine Use of Statins" continues...
501291 -
501292 - 24. Dr Paul M Ridker, the director of the center for cardiovascular
501293 - disease prevention at Brigham and Womens Hospital, in Boston,
501294 - said he worried the new guidelines could easily lead to
501295 - overtreatment. An older man with a low LDL level who smokes
501296 - and has moderately elevated blood pressure would qualify for a
501297 - statin under the new guidelines. But what he really needs is
501298 - to stop smoking and get his blood pressure under control.
501300 - ..
501301 - 25. Dr Stone said he hoped doctors would not reflexively prescribe
501302 - a statin to such a patient. Doctors are supposed to talk to
501303 - their patients and realize that, with a man like the one Dr
501304 - Ridker described, the real problem was not cholesterol.
501306 - ..
501307 - 26. "We are taking people out of their comfort zone," Dr. Stone
501308 - said. "Instead of being reassured that reaching this number
501309 - means they will be fine, we are asking, What is the best
501310 - therapy to do the job?"
501311 -
501312 -
501314 - ..
501315 - Another article on the same subject...
501316 -
501317 - 1. New York Times
501319 - ..
501320 - 2. November 12, 2013 1630 EST
501321 -
501322 - 3 Things to Know About the New Cholesterol Guidelines
501323 - By HARLAN M. KRUMHOLZ, M.D........... ref SDS 0 HW43
501324 -
501325 - http://well.blogs.nytimes.com/2013/11/12/3-things-to-know-about-the-new-cholesterol-guidelines/?ref=health
501327 - ..
501328 - 3. The American College of Cardiology and the American Heart
501329 - Association just released new cholesterol guidelines to reduce
501330 - atherosclerotic cardiovascular risk - and the change from the
501331 - previous version, last updated in 2004, is profound. Here are
501332 - three things you need to know about these new guidelines.
501334 - ..
501335 - 4. First, the guidelines have moved away from achieving target
501336 - cholesterol levels.
501338 - ..
501339 - 5. Americans have long been urged to focus on their laboratory
501340 - numbers. Many people are obsessive about checking their
501341 - cholesterol levels and pursuing even better numbers. Doctors
501342 - have been told to focus on these numbers and, in some cases,
501343 - the quality of their care was assessed by the percentage of
501344 - their patients with low cholesterol levels.
501346 - ..
501347 - 6. Those days are over. The new guidelines recognize that for
501348 - patients who have exhausted lifestyle efforts and are
501349 - considering drug therapy, the question is not whether a drug
501350 - makes your lab tests better, but whether it lowers your risk of
501351 - heart disease and stroke. Studies over the past several years
501352 - have shown that improving your lab profile with drugs is not
501353 - equivalent to lowering your heart risks. Drugs have thousands
501354 - of effects on the body, and a drug's effect on an individual
501355 - lab test cannot necessarily predict its overall effect on you.
501357 - ..
501358 - This part of the report that taking drugs to lower lab profile for
501359 - lipids, particularly LDL, does not necessarily lower risks of coronary
501360 - disease and stroke, and that drugs have many adverse effects on the
501361 - body, aligns with patient history reported in Doctor Egan in the
501362 - letter on 131016 1632. ref SDS 4 IW5J
501364 - ..
501365 - Another article today, claims lowering cholesterol harms the body
501366 - because cholesterol supports 5 vital functions required for good
501367 - health. ref SDS 0 HC5L - digestion, memory, sex, immunity, and
501368 - prevents cancer.
501370 - ..
501371 - Article "3 Things to Know About the New Cholesterol Guidelines" continues...
501372 -
501373 - 7. Importantly, the guidelines still state that cholesterol is
501374 - important. But the point is that changing your cholesterol
501375 - level with medications is now accompanied with the appreciation
501376 - that other effects of the drugs may offset any benefit to
501377 - reducing cholesterol.
501379 - ..
501380 - 8. There's one exception to the numbers rule. People with very
501381 - high cholesterol still need to worry about targets. The new
501382 - guidelines set that level at 190 milligrams per deciliter - but
501383 - the principle is that if people have very high cholesterol
501384 - levels, then their cardiovascular risk is so high that it is
501385 - likely that treatment to reduce the levels would offset any
501386 - risks of the drug treatment.
501388 - ..
501389 - 9. So, the new guidelines are saying: we should not be chasing the
501390 - cholesterol levels alone. The "know your number" campaign is
501391 - no longer consistent with the guidelines, and the days of
501392 - doctors adding additional medications to get you to some
501393 - arbitrary cholesterol level should no longer occur.
501395 - ..
501396 - 10. Second, know your risk.
501398 - ..
501399 - 11. What is taking the place of cholesterol levels? What should you
501400 - do now?
501402 - ..
501403 - 12. The guidelines are now focusing you on your overall risk of
501404 - heart disease and stroke. They indicate that drug treatment is
501405 - recommended for people with a high risk - and that more
501406 - powerful treatments are best for those with the highest risk.
501408 - ..
501409 - 13. So what they are saying now is: know your risk of heart disease
501410 - and stroke. They have published an online calculator to help
501411 - you - but more important is the general concept that drug
501412 - treatment with effective medications (those proven to lower
501413 - risk) should be used in people with the most to gain.
501415 - ..
501416 - 14. The guidelines do set thresholds for risk, but my view is that
501417 - these recommendations should not be considered dictums to be
501418 - followed without question. They say that if your 10-year risk
501419 - of heart disease and stroke is 7.5 percent or higher, then you
501420 - should be treated with drugs. However, I believe that only you
501421 - can determine what constitutes a high enough risk that it is
501422 - worth it to you to be treated with drugs. Such a decision
501423 - depends on how you feel about your risk of heart disease and
501424 - stroke and how you feel about taking drugs - and their risks
501425 - and benefits.
501427 - ..
501428 - This paragraph presents a tautology, sort of circular reasoning.
501429 - Patients feel the risk of heart attack derives from the condition of
501430 - their body, and feel the risk of taking drugs should be less than the
501431 - risk of coronary artery disease.
501433 - ..
501434 - How is the value 7.5% calculated for 10-year risk of heart disease or
501435 - stroke? What are the elements and how are they derived?
501437 - ..
501438 - Research below, shows source for the Farmingham cardiovascular
501439 - calculator. ref SDS 0 K55L Further research indicates that CAD
501440 - patients should not apply these calculators.
501442 - ..
501443 - Article "3 Things to Know About the New Cholesterol Guidelines" continues...
501444 -
501445 - 15. Third, use medications proven to reduce risk.
501447 - ..
501448 - 16. The understanding that simply improving cholesterol lab tests
501449 - may not reduce your risk for heart attack and stroke has
501450 - focused attention on the choice of drug therapy. In the "treat
501451 - to target" era, there was a sense that we could use any of the
501452 - medications to lower LDL - and what was most important was the
501453 - lab test.
501455 - ..
501456 - 17. However, there have been numerous studies showing that many
501457 - popular drugs that may have improved lab tests for cholesterol
501458 - failed to reduce risk. These studies led the authors of the
501459 - guidelines to make a distinction between proven and unproven
501460 - medications.
501462 - ..
501463 - Increasing LDL 70 to LDL 190, may reflect reporting in another article
501464 - today, that the body needs cholesterol, including LDL for vital
501465 - functioning. ref SDS 0 9K6K
501467 - ..
501468 - Article "3 Things to Know About the New Cholesterol Guidelines" continues...
501469 -
501470 - 18. Thus, the focus of the guidelines is on statins, the drug class
501471 - with clear evidence that it can lower risk in many groups of
501472 - patients. In fact, statins seem to lower risk regardless of
501473 - your cholesterol levels. This fact has led many of us to think
501474 - about statins as risk-reduction medications rather than just
501475 - medications that modify cholesterol levels. Regardless, the
501476 - evidence that statins lower risk is very clear.
501478 - ..
501479 - This sounds like prescriptions to take aspirin, regardless of patient
501480 - health.
501482 - ..
501483 - What studies show this? What were patient profiles of study
501484 - participants? How did level of medication prescribed correlate to
501485 - level of exercise, and to severity of side effects?
501487 - ..
501488 - Why do researchers believe taking statins reduce cardiovascular risks,
501489 - other than by lowering cholesterol?
501491 - ..
501492 - Article "3 Things to Know About the New Cholesterol Guidelines" continues...
501493 -
501494 - 19. So the guidelines now make clear that if you use drug therapy
501495 - for higher risk, you should use statins. If you cannot
501496 - tolerate one statin, you might want to try another statin,
501497 - after consultation with your doctor. If you use another type
501498 - of drug, then you should know whether that drug has been shown
501499 - to reduce risk in contemporary studies. Many popular drugs,
501500 - like Zetia (ezetimibe), have yet been proven to save lives.
501502 - ..
501503 - 20. Bottom line: The new guidelines are a marked departure from the
501504 - era of chasing targets and being agnostic to the drugs you
501505 - used. The new message is dont chase targets, know your risk,
501506 - and if you need drug therapy use statins. These principles
501507 - should guide your discussions with your doctor.
501509 - ..
501510 - 21. Harlan Krumholz is a cardiologist and the Harold H. Hines Jr.
501511 - Professor of Medicine, director of the Yale-New Haven Hospital
501512 - Center for Outcomes Research and Evaluation (CORE) and director
501513 - of the Robert Wood Johnson Clinical Scholars Program at Yale
501514 - University School of Medicine.
501515 -
501517 - ..
501518 - A 3rd article published on this issue...
501519 -
501520 - 1. Reuters
501521 -
501522 - New heart guidelines back stronger therapies for high risk patients
501523 -
501524 - By Bill Berkrot
501525 -
501526 - November 12, 2013
501528 - ..
501529 - 2. New US guidelines on heart health that were a decade in the
501530 - making recommend stronger measures for patients at particularly
501531 - high risk of heart attack or stroke, including more aggressive
501532 - therapy with drugs that lower cholesterol or even bariatric
501533 - weight loss surgery.
501535 - ..
501536 - 3. The guidelines issued by two leading US medical organizations
501537 - on Tuesday are likely to be followed by cardiologists and
501538 - primary care physicians, as well as influence insurance
501539 - coverage. They still emphasize a healthy diet and exercise as
501540 - keys to avoiding the No. 1 killer in the country.
501542 - ..
501543 - 4. They stopped short of setting lower target levels for "bad"
501544 - LDL cholesterol of 70 or lower, and focused instead on
501545 - identifying high risk patient groups likely to most benefit
501546 - from more intensive treatment with cholesterol lowering statin
501547 - drugs.
501549 - ..
501550 - 5. The long-awaited new guidelines announced by the American
501551 - College of Cardiology (ACC) and American Heart Association
501552 - (AHA) came in the form of four reports: one on managing blood
501553 - cholesterol; one on managing overweight and obese patients;
501554 - one for assessing cardiovascular risk in adults; and one on
501555 - heart disease prevention through healthy lifestyle.
501557 - ..
501558 - 6. The project was begun by the National Heart, Lung and Blood
501559 - Institute, which studied and compiled data before handing off
501560 - to ACC and AHA this year to translate findings into clinical
501561 - practice guidelines and publish the reports. Since the experts
501562 - did not consider clinical data or scientific evidence
501563 - available later than 2011, they plan to begin work updating
501564 - the guidelines next year.
501566 - ..
501567 - 7. The cholesterol management guidelines, if followed in
501568 - practice, could lead to more extensive use of high potency
501569 - statins, such as AstraZeneca's Crestor and higher doses of
501570 - Pfizer's Lipitor, now available as generic atorvastatin. They
501571 - could also lead to reduced use of lower dose generic statins
501572 - and perhaps far less use of non-statin cholesterol medicines,
501573 - such as Merck's Zetia and AbbVie's Tricor, which the report
501574 - said lacked evidence of reducing heart attacks and death.
501576 - ..
501577 - 8. Merck has a large study underway of its Vytorin combination
501578 - cholesterol treatment that should definitively prove whether
501579 - use of Zetia prevents heart attacks and strokes.
501581 - ..
501582 - 9. "Non-statins didn't provide enough risk prevention," Dr Neil
501583 - Stone, lead author of the cholesterol report, said in a
501584 - conference call. He noted that there has been "over treatment
501585 - by drugs not proven to add incremental benefit."
501587 - ..
501588 - 10. The four groups deemed most likely to benefit from higher
501589 - intensity statin treatment were: Patients with known heart
501590 - disease; those with an LDL level of 190 or higher; patients
501591 - with type 2 diabetes between the ages of 40 and 75; those
501592 - between 40 and 75 deemed to have a 10-year risk of developing
501593 - heart disease of 7.5 percent or higher based on new risk
501594 - assessment formulas.
501596 - ..
501597 - 11. OBESITY CRISIS
501598 -
501599 - With nearly 155 million Americans classified as overweight or
501600 - obese, treating the obesity epidemic was a cornerstone of the
501601 - new guidelines. Obesity, which leads to diabetes, heart
501602 - disease and other serious health problems, adds an estimated
501603 - $190 billion in annual medical costs, according to healthcare
501604 - economists.
501606 - ..
501607 - 12. The guidelines still use Body Mass Index (BMI), a measure of
501608 - ideal weight in relation to height, to identify patients at
501609 - high risk of developing heart disease. It strongly recommends
501610 - in-person counseling as part of programs to help patients
501611 - maintain weight loss, with 14 sessions over six months seen as
501612 - ideal.
501614 - ..
501615 - 13. Under President Barack Obama's Affordable Care Act, commonly
501616 - referred to as Obamacare, most private insurance companies are
501617 - expected to cover counseling and other obesity treatments.
501619 - ..
501620 - 14. "Telling patients or advising patients that they need to lose
501621 - weight is not enough," said Dr. Donna Ryan, co-chair of the
501622 - obesity report writing committee.
501624 - ..
501625 - 15. Counseling should focus on patients with other conditions that
501626 - heighten the risk of heart disease, such as high blood
501627 - pressure, high cholesterol, diabetes, or a waist circumference
501628 - of more than 35 inches for women and 40 inches for men, the
501629 - obesity management report said.
501631 - ..
501632 - 16. The most drastic recommendation said bariatric weight loss
501633 - surgery for adults with a BMI of at least 40, or 35 or higher
501634 - for those with two other risk factors such as high blood
501635 - pressure or diabetes, may provide significant health benefits.
501636 - Adding that recommendation to the U.S. guidelines is likely to
501637 - help justify coverage for the procedures by health insurers.
501639 - ..
501640 - 17. Another recommendation for reducing heart risk said there
501641 - should be a focus on achieving sustained weight loss of 5
501642 - percent to 10 percent within the first six months.
501644 - ..
501645 - 18. "Physicians should counsel patients that lifestyle changes that
501646 - produce even modest weight loss can result in clinically
501647 - meaningful health improvements," Ryan said.
501649 - ..
501650 - 19. The new guidelines could help boost sales of two new
501651 - prescription weight loss drugs - Belviq from Arena
501652 - Pharmaceuticals Inc and Vivus Inc's Qsymia. Those medicines
501653 - were not considered for the guideline reports as they were not
501654 - available by 2011.
501656 - ..
501657 - 20. The panel looked at about 17 different weight loss diets before
501658 - deciding not to recommend any specific ones.
501660 - ..
501661 - 21. "We came down loud and clear that there is no ideal diet for
501662 - weight loss and there is no superiority for any of the diets
501663 - that we examined," Ryan said.
501665 - ..
501666 - 22. The healthy living clinical practice guidelines for lowering
501667 - heart disease risk called for 40 minutes of moderate to
501668 - vigorous-intensity aerobic exercise three to four times a week,
501669 - and a diet in which levels of saturated fat, trans fat and
501670 - sodium are below what is currently consumed by the average
501671 - American. The US Food and Drug Administration last week
501672 - proposed banning trans fat from processed foods.
501674 - ..
501675 - 23. Not surprisingly, the report recommends a diet that emphasizes
501676 - fruits, vegetables, whole grains, fish and nuts while limiting
501677 - red meat, sweets and sugar-sweetened beverages.
501678 -
501679 - (Reporting by Bill Berkrot; editing by Michele Gershberg and
501680 - Andrew Hay)
501681 -
501682 -
501683 -
501684 -
5017 -
SUBJECTS
Default Null Subject Account for Blank Record
5103 -
510401 - ..
510402 - Cardiovascular Risk Calculations
510403 -
510404 - Seems to turn out that risk calculators are not good tools to evaluate
510405 - medication requirements for patients with history of CABG, which was
510406 - performed on 091022 0700. ref SDS 1 PQWU
510408 - ..
510409 - There is a source on the Interent for...
510410 -
510411 - Cardiovascular Risk Calculator
510412 -
510413 - http://www.patient.co.uk/doctor/cardiovascular-risk-calculator
510415 - ..
510416 - This risk calculator uses the Framingham risk equation[1] and
510417 - the adjustments as suggested by the Joint British Societies'
510418 - (JBS2) paper[2] and the JBS Cardiovascular Risk Assessor.[3]
510420 - ..
510421 - It is not the only risk calculator in use. In 2010 the
510422 - National Institute for Health and Clinical Excellence (NICE)
510423 - decided it could no longer recommend that the Framingham risk
510424 - equation be used, as it tends to over-estimate risk by
510425 - approximately 5% in UK men.[4] The decision also coincides
510426 - with the emergence of the QRISK calculator which has been shown
510427 - to predict risk more accurately. The QRISK calculator is
510428 - available at
510429 -
510430 - http://www.qrisk.org
510432 - ..
510433 - For further information on QRISK see our cardiovascular risk
510434 - assessment article.
510436 - ..
510437 - Cardiovascular Risk Calculator For Primary Prevention
510439 - ..
510440 - This calculator should not be used if patient has known CVD or
510441 - diabetes (already known to be at high risk)
510443 - ..
510444 - Age 30-74............... 68
510446 - ..
510447 - Smoking status.......... non
510449 - ..
510450 - Sex..................... Male
510452 - ..
510453 - Glucose................. Normal
510455 - ..
510456 - LVH..................... No LVH
510458 - ..
510459 - Central Obesity......... No
510461 - ..
510462 - South Asian Origin...... No
510464 - ..
510465 - Family History CVD...... No
510467 - ..
510468 - Systolic BP............. 115
510470 - ..
510471 - Diastolic BP............ 65
510473 - ..
510474 - Total Cholesterol....... 70 ....10-year risk CHD.... 2%
510475 - Total Cholesterol....... 120 ....10-year risk CHD.... 5%
510476 - Total Cholesterol....... 190 ....10-year risk CHD.... 10%
510477 - Total Cholesterol....... 321 ....10-year risk CHD.... 18%
510479 - ..
510480 - HDL Cholesterol......... 57
510482 - ..
510483 - Total/HDL Ratio......... 2.11
510485 - ..
510486 - Serum TG mmo/L..........
510488 - ..
510489 - Systolic BP Predition, 10-year risk CHD Risk 5%
510491 - ..
510492 - Diastolic BP Predition, 10-year risk CHD Risk 5%
510493 -
510494 -
510495 -
510496 -
510497 -
5105 -
SUBJECTS
Hyperlipidemia Clinical Trials Meeting Agenda LDL 248 Cholesterol SF
9303 -
930401 - ..
930402 - Cholesterol Aids Digestion, Cognition, Immune System, Produces Hormones
930403 - Cholesterol Essential for Life Digestion Cognition Immunity Hormones
930404 -
930405 - Another article says...
930406 -
930407 - New Cholesterol Guidelines: Utter Madness
930408 -
930409 - by DR JONNY BOWDEN
930410 -
930411 - http://jonnybowdenblog.com/new-cholesterol-guidelines
930413 - ..
930414 - 1. Usually I try to write these newsletter articles with a
930415 - modicum of objectivity and fairness, checking my passion at
930416 - the gate. But this latest travesty from the Cholesterol
930417 - Establishment is simply too much to take sitting down.
930419 - ..
930420 - 2. On Nov 11, The National Heart, Lung and Blood Institute
930421 - issued new guidelines on cholesterol.
930422 - They now advise screening for all children between 9-11.
930423 - Let me tell you in no uncertain terms why this is utterly
930424 - ridiculous.
930426 - ..
930427 - 3. Number One: Cholesterol is a homrone factory.
930428 -
930429 - Cholesterol is actually the parent molecule for the whole
930430 - family of hormones known as steroid hormones. These
930431 - hormones include cortisol (known as the "flight or fight"
930432 - hormone), and the entire family of sex steroids including
930433 - the estrogens, progesterone and testosterone. The sexual
930434 - side effects of statin drugs has been well documented, and
930435 - was even the subject of an entire book by one of the top
930436 - cholesterol researchers in the world, Michel de Lorgeril,
930437 - MD. Do we really want to put children on a drug that can
930438 - conceivably impact their entire sexual development?
930439 - Really?
930440 -
930441 - [On 131125 0005 Doctor Attia article reports cholesterol
930442 - is essential for life. ref SDS 7 FU5N
930444 - ..
930445 - 4. Number two: Cholesterol is used by the body to synthesize
930446 - bile acids.
930448 - ..
930449 - Bile acids vitally important for the digestion of fat.
930450 - They're synthesized from cholesterol and then secreted into
930451 - the bile. Bile acids are so important to the body that it
930452 - holds onto most of them, keeping them from being lost in
930453 - the feces and instead causing them to be reabsorbed from
930454 - the lower intestine, put into a kind of "metabolic
930455 - recycling" container and taken back to the liver. Still,
930456 - even with its best efforts, the body loses some bile acids
930457 - and to make up for this, the liver synthesizes
930458 - approximately 1500-2000 mg of new cholesterol a day (that's
930459 - about 7-10 times the amount in a large egg). Clearly the
930460 - body thinks you need that cholesterol.
930461 -
930462 - [On 131125 0005 Doctor Attia article reports cholesterol
930463 - is essential for life. ref SDS 7 VP5H
930465 - ..
930466 - 5. Number three: Cholesterol is an essential component of
930467 - cell membranes
930469 - ..
930470 - Cholesterol is an essential part of the membranes of the
930471 - brain, the nervous system, the spinal cord and the
930472 - peripheral nerves. It?s incorporated into the myelin
930473 - sheath, a kind of insulation or "cover" for the nerve
930474 - fibers that facilitates nerve impulse transmission.
930475 - Cholesterol is also important for stabilizing cells against
930476 - temperature changes. Memory and cognition problems are one
930477 - of the most common side effects of statin drugs. (For more
930478 - on this, see Dr. Duane Graveline?s frightening book,
930479 - ?Lipitor: Thief of Memory?.)
930481 - ..
930482 - Did not take Lipitor in order to avoid side effects of impaired
930483 - memory and cognition.
930485 - ..
930486 - Article "New Cholesterol Guidelines: Utter Madness" continues...
930487 -
930488 - 6. Number four: Cholesterol is important for the Immune
930489 - System.
930491 - ..
930492 - Cholesterol has an important connection to the immune
930493 - system. Research has shown that human LDL (so-called ?bad?
930494 - cholesterol) is able to inactivate over 90 percent of the
930495 - worst and most toxic bacterial products(1-4).
930496 -
930497 - [On 131125 0005 Doctor Attia article reports cholesterol
930498 - is essential for life. ref SDS 7 FU5N
930500 - ..
930501 - And a number of studies have linked low cholesterol with a
930502 - greater risk of infections. One review of 19 large,
930503 - peer-reviewed studies of more than 68,000 deaths found that
930504 - low cholesterol predicted an increased risk of dying from
930505 - respiratory and gastrointestinal disease, both of which
930506 - frequently have an infectious origin. Another study that
930507 - followed more than 100,000 healthy individuals in San
930508 - Francisco found that those who had low cholesterol at the
930509 - beginning of the 15?year study were far more likely to be
930510 - admitted to the hospital because of an infectious
930511 - disease.(1,2). And an interesting finding from the MRFIT
930512 - study found that 16 years after their cholesterol was first
930513 - checked, the group of men whose cholesterol level was 160
930514 - or less were four times more likely to die from AIDS than
930515 - the group of men whose cholesterol was over 240! (3)
930517 - ..
930518 - 7. Number five: Cholesterol is the parent molecule for
930519 - vitamin D
930521 - ..
930522 - It's well known that an enormous number of people - perhaps
930523 - over 50% of the population in this country, though exact
930524 - figures aren't known - have far less than the optimal
930525 - amount of vitamin D in their systems. Low levels of
930526 - vitamin D have been linked to depression, cancer, physical
930527 - performance, weakened immunity, the inability to lose
930528 - weight and even overall life expectancy. Could the huge
930529 - number of vitamin D deficiency clinicians are seeing on a
930530 - regular basis be partly due to the overuse of statin drugs?
930531 - It?s hard to know?but it passes the smell test.
930532 -
930533 - [On 131125 0005 Doctor Attia article reports cholesterol
930534 - is essential for life. ref SDS 7 FU5N
930536 - ..
930537 - 8. Do you really want to put a kid on a drug that's going to
930538 - clearly impact his body's ability to make this vital,
930539 - important nutrient?
930541 - ..
930542 - 9. But the biggest, most glaring reason the idea of screening
930543 - kids for high cholesterol is boneheaded is this:
930544 - Cholesterol doesn't cause heart disease.
930546 - ..
930547 - 10. No folks, we've been completely mislead, lied to,
930548 - bamboozled and just plain misinformed.
930550 - ..
930551 - 11. I consider the cholesterol book I'm currently working on
930552 - with Dr Sinatra to be the most important work I've ever
930553 - done. Heart disease is the number one killer in the world,
930554 - and people need to stop focusing on cholesterol and get to
930555 - work on what the real issues in heart disease:
930556 -
930557 - inflammation
930558 - infections
930559 - oxidation
930560 - glycation
930561 - stress
930562 -
930564 - ..
930565 - The author does not present work to perform on these factors that he
930566 - claims reduce risk of CAD in greater measure than statin medications.
930568 - ..
930569 - The articles today cite the AHA claiming large clinical trials
930570 - indicate statin medication lowers incidence of heart attack, whether
930571 - or not it lowers cholesterol, per above. ref SDS 0 KW6L
930573 - ..
930574 - This could be interpreted to indicate main stream health care accepts
930575 - that cholesterol is important to good health, as maintained by the
930576 - author, per above. ref SDS 0 HC5L
930578 - ..
930579 - If statins are reducing incidence of CAD and heart attacks, how is
930580 - this occurring other than by lowering cholesterol? Do statins treat
930581 - any of the following cited by the author as causing heart problems...
930582 -
930583 - inflammation
930584 - infections
930585 - oxidation
930586 - glycation
930587 - stress
930588 -
930589 -
930591 - ..
9306 -
9307 -
9308 - 2201
9309 -
930901 - Letter to Kathy says...
930902 -
930903 - 1. Subject: Agenda Meeting VA SF Med Center Statins and Clinical Trials
930904 - Date: Tue, 12 Nov 2013 22:10:16 -0800
930911 - ..
930912 - 2. What did you draw from the source in your letter earlier today,
930913 - shown below?
930915 - ..
930916 - 3. Several articles report new guidelines issued by AHA that
930917 - increase from 70 to LDL 190, and further proposes prescribing
930918 - statins for patients at risk for CAD, which is my patient
930919 - profile. ref SDS 0 0001
930921 - ..
930922 - 4. Another article presents risks of statins, which are manifest
930923 - in my patient profile. The article further lists seemingly
930924 - powerful benefits of cholesterol, including LDL for
930925 - strengthening the immune system. ref SDS 0 HC5L
930927 - ..
930928 - 5. How should these issues be presented in the agenda for meeting
930929 - next week on 131121? [...cited in the record today, shown
930930 - above. ref SDS 0 HP7I
930932 - ..
930933 - 6. Rod
930934 -
930935 -
930936 -
930937 -
930938 -
930939 -
930940 -
930941 -
930942 -
930943 -
930944 -
930945 -
9310 -