THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: November 25, 2013 00:05 AM Monday;
VA confirm understandings meetings at SF Medical Center on treating arterialsclorosis.
2...Hyperlipidemia Not Controlled Cholesterol Elevated Despite Exercise
3...Cholesterol Elevated Despite Exercise Discuss Clinical Trial
4...Clinical Trial Considered Lower Cholesterol Without Statin Drugs
5...Lipid Lab LDL HDL TG Conflicts Hiking Weight Loss
6...Lab Lipid LDL HDL TG Conflicts Hiking Weight Loss
7...Cholesterol Elevated Despite Exercise Weight Loss
8...Hyperlipidemia Not Controlled Cholesterol Elevated Despite Exercise
9...Wicked Problems Good Condition Hiking Weight Loss Masks Poor Health
10...Good Condition False Positive Hiking Weight Loss Masks Poor Health
11...Hiking Good Condition Masks Poor Health CVD with High LDL-P
12...False Positive Patient Good Condition Hiking Masks Rising CVD
13...Atorvastatin Prescribed with Ezetimibe Increase HDL Lower Triglycerides
14...Hyperlipidemia Clinical Trials Resolve Non-statin Drugs Investigations
15...Clinical Trials Resolve Hyperlipidemia Non-statin Drugs Investigations
16...Investigations Clinical Trials Resolve Hyperlipidemia Non-statin Drugs
17...Work Plan Atorvastan 4-week Trial then Add Ezetimibe
18...Karen Coordinated Communications Starting Trial Atorvastatin
19...Clinical Trial PCSK9 VA Conctact UCSF Resolve Hyperlipidemia
20...Ezetimibe (Zetia) with Atorvastatin Promising Lower CVD Risk Hyperlipidemia
21...Atorvastatin with Ezetimibe (Zetia) Promising Lower CVD Risk Hyperlipidemia
............Safety and Efficacy of Ezetimibe Added to Atorvastatin Versus
............Up Titration of Atorvastatin to 40 mg in Patients >=65 Years
............of Age (from the ZETia in the ELDerly [ZETELD] Study)
........Clinical Investigation and Reports
........Effect of Ezetimibe Coadministered With Atorvastatin in
........628 Patients With Primary Hypercholesterolemia
22...Atorvastatin 10 Ezetimibe 10 HDL 5% Increase TG 30% LDL-C 50% Reduction
23...HDL 5% Increase TG 30% LDL-C 50% Reduction Atorvastatin 10 Ezetimibe 10
24...Side Effects Atorvastatin 10 MG with Ezetimibe 10 MB
25...Ezetimibe 10 MB Side Effects with Atorvastatin 10 MG
26...Side Effects Ezetimibe 10 MB with Atorvastatin 10 MG
27...VA Confirm Work Plan Atorvastan 4-week Trial then Add Ezetimibe
28...Notify Doctor Alba Implement Prescription Atorvastatin Manage Cholesterol
29...Research Arterialsclorsis Cornorary Artery Disease and Cholesterol
30...High LDL-C Low LDL-P Discordance Lowers Risk Shown by TG HDL-C Ratio 2
....1...Tim Russert's Fatal Heart Attack Was Preventable, He Followed
31...Exercise Russert Overweight Died Low HDL High TG Despite LDL 70
32...Russert Died Low HDL and High TG Several Years Excess Weight
33...Triglycerides High HDL Low Russert Died CVD with Low LDL Excess Weight
34...HDL Low Triglycerides High Russert Died CVD with Low LDL Excess Weight
35...Exercise Bike Failed Russert Overweight
36...Low-Carb Diet Lower Triglycerides Large LDL Particle Size Protective
37...LDL 246 Cholesterol 326 Healthy with TG 77 HDL 65
38...LDL-P Size Large Fluffy Protective with HDL 65 and TG 77
39...Protective LDL Particle Large Size Fluffy with HDL 65 and TG 77
40...Low Carb Diet TG/HDL Ratio 2 Lower Risk Arterialsclorosis CVD
41...TG/HDL Ratio 2 Low Carb Diet Lower Risk Arterialsclorosis CVD
42...Ratio TG/HDL 2 Low Carb Diet Lower Risk Arterialsclorosis CVD
43...Cholesterol Bound Atherogenic Lipoproteins Causes Aterialsclorosis
44...Triglycerides Indicate Small LDL Particle Size High Risk CVD
45...High LDL Particle Count Indicates Cholesterol Depleted LDL
46...Artiarialsclorosis Caused by High Number LDL Particles LDL-P
47...Cholesterol in LDL Particles Not Causative Artialsclorosis
48...LDL-C Low May Indicate High Risk CVD Arterialsclorsis Discordance
49...Discordance Low LDL-C May Indicate High Risk CVD Arterialsclorsis
50...ApoB LDL-P Both Predict Risk CVD Arterialsclorsis Better than LDL-C
51...LDL-P Size Small 300% Greater Risk CVD Large LDL-P Cholesterol Protective
52...Large Fluffy LDL Particles Protective 300% Lower Risk than Small Dense LDL
53...Lipid Panal ApoB LDL-P Assess CVD Risk Better than LDL-C Misleading
54...CVD Risk High LDL-P High and LDL-C Low Metabolic Syndrome Means Overweight
55...LDL-P High and LDL-C Low High Risk CVD Metabolic Syndrome Means Overweight
56...Metabolic Syndrome Means Overweight LDL-P High and LDL-C Low High Risk CVD
57...LDL-C Lower Statins Misleading Don't Lower LDL-P ApoB
58...Statin Medication Lowers LDL-C More than LDL-P Misleading
59...Niacin Low-Carbohydrate Diet Reduces Triglycerides Lowers LDL-P
60...Triglycerides Lower Exercise Weight Loss Fibrates Niacin
61...LDL-P Lowered by Exercise Low-Carbohydrate Diet Reduces Triglycerides
62...Carbohydrate Restriction Lowers LDL-P by Lowering Triglycerides
63...Exercise Lowers LDL-P
64...LDL-C Limited Value Misleading Risk Assessment Arterialsclorosis
65...Metabolic Syndrome TG High HDL Low LDL-P ApoB High LDL-C Low Misleading
66...LDL-C Low Misleading Metabolic Syndrome TG High HDL Low LDL-P ApoB High
67...Lipid Panal ApoB LDL-P Assess CVD Risk Better than LDL-C Misleading
68...CVD Risk High LDL-P High and LDL-C Low Metabolic Syndrome Means Overweight
69...LDL-P High and LDL-C Low High Risk CVD Metabolic Syndrome Means Overweight
70...Metabolic Syndrome Means Overweight LDL-P High and LDL-C Low High Risk CVD
71...Metabolic Syndrome Overweght Obese TG/HDL Ratio > 3.5
72...Overweght Metabolic Syndrome TG/HDL Ratio > 3.5 Obese
73...Obese Metabolic Syndrome Overweght TG/HDL Ratio > 3.5
74...TG/HDL Ratio > 3.5 Apply When LDL-P ApoB Not Available Lipid Panel
75...Diagram LDL Particle Count Higher Triglycerides Rich/Cholesterol Depleted
76...Attia Article Explain Concordant Discordant LDL Particles
77...Cholesterol Essential for Life Background Articles Doctor Attia
78...Eating Cholesterol Excreted Not Major Factor Arterialsclorosis CVD
79...Cholesterol Eating Excreted Not Major Factor Arterialsclorosis CVD
80...Eating Cholesterol Little Effect on Health and Lipid Blood Tests
81...LDL HDL Lipoproteins Transport Cholesterol Triglycerides
82...Cholesterol Triglycerides Transported Lipoproteins HDL LDL
83...Triglycerides Cholesterol Transported Lipoproteins HDL LDL
84...Lipoproteins Cholesterol Triglycerides Transported HDL LDL
85...Apoprotiens ApoB in LDL and ApoA-I in HDL Produced in Liver
86...ApoB in LDL and ApoA-I in HDL Apoprotiens Produced in Liver
87...Lipid Panel Cholesterol Total, Triglycerides, HDL LDL-C Estimated
88...LDL-P Test Count Particles and Measure Particle Size - NMR LipoProfile
89...NMR LipoProfile Test Count LDL-P Particles and Measure Particle Size
90...Lipid Test NMR LipoProfile Count LDL-P Particles and Measure Particle Size
91...LDL Particle Count Lower Reduce Risk Arterialsclorosis
92...Arterialsclorosis ApoB LDL Particle Penetrates Endothelial Artery Lining
93...Endothelial Artery Lining ApoB LDL Particle Penetrates Arterialsclorosis
........2...Concept #8 - Why is it necessary to measure LDL-P, instead of just LDL-C?
94...LDL-P 1000 nmol/L Target Reduce Risk CVD Event
95...CVD Risk Lowest Discordant LDL-P Low 1060 LDL-C High >= 100
96...Atherosclerosis Lowest CVD Risk LDL-P Low LDL-C High Discordant
97...LDL-P Low LDL-C High Discordant Lowest Risk CVD Atherosclerosis
98...Discordant LDL-P Low LDL-C High Least Risk CVD Arterialsclorsis
99...Frequency Discordance About 20% LDL-P Low LCL-C High
100...Discordant Population 20% LDL-P 1060 "Low" LDL-C >= 100 "High"
101...Doctors Do Not Know Some People Elevated LDL-C Low Risk CVD
........The straight dope on cholesterol - Part V (5)
102...TG/HDL Ratio with TG 100 and HDL > 50 Low CVD CAD Risk
103...CVD Risk Triglyceride HDL Ratio Substitute to Measure LDL-P
104...Triglyceride HDL Ratio Substitute Measure LDL-P Assess CVD Risk
105...TG/HDL Ratio 2 Indicates Dense/Small LDL Particle Size
106...LDL Particle Size Assessment Triglycerides/HDL Ratio
107...Exercise HDL Increase with Orange and Cranberry Juice
108...Orange Juice Exercise Increase HDL and Cranberry
109...HDL Exercise Increase with Orange and Cranberry Juice
110...Orange Juice Increased HDL 21% 750 ML Per Day Over 4 Weeks
111...HDL 21% Orange Juice Increased 750 ML Per Day Over 4 Weeks
112...Exercise Jim Fixx Infrequent Caused Heart Attack Running 10 Miles
113...Fixx Jim Myocadial Infarction Heart Attack Running 10 Miles
114...Jim Fixx Died CVD While Running 10 Miles Training for Marathons
115...Russert HDL Low TG High BP Elevated Overweight Enlarged Heart
116...Russert High TG Low HDL High Blood Pressure Overweight
117...Risk Factors Cardiovascular Disease Blocked Artery Heart Attack
118...Cardiovascular Disease Blocked Artery Heart Attack Risk Factors
119...Arterialsclorosis Myocardial Infarction Heart Attack Risk Factors
120...Russert CT Score 210 Should be 0
121...Artherosclerosis Coronary CTA and IVUS Measure Plaque
122...Coronary CTA and IVUS Arterialsclorsis Plaque Measure
123...IVUS and Coronary CTA Arterialsclorsis Plaque Measure
............Coronary Atherosclerosis Imaging by Coronary CT Angiography
124...CT Assess Arterialsclorsis Plaque Difficult Requires Equip Expertise
............Assessment of coronary plaque progression in coronary
............computed tomography angiography using a semiquantitative score.
125...Exercise HDL Increase Aerobic Long Duration Lose Weight
126...HDL Increase Exercise Aerobic Long Duration Lose Weight
127...Aerobic Exercise Long Duration Lose Weight Increase HDL
128...Weight HDL Increase Lose Weight Aerobic Long Duration Exercise
129...HDL Lose Weight Aerobic Exercise
130...HDL Increased with Drugs Caused Increased Cardiac Risk
131...Processed Food Chips Donuts High Trans Saturated
132...LDL Increase Saturated and Trans Saturated Acids
133...Saturated and Trans Saturated Acids Increase LDL
134...Trans Saturated and Saturated Acids Increase LDL
................Trans Fatty Acids and the Heart
................They're everywhere, and they may be worse than lard
135...Trans Acids Decrease HDL and Increase LDL Cholesterol
136...Test LDL Small Dense Particle Size CAD Patients
137...Triglycerides Lower Exercise Weight Loss Niacin Fibrates Increase LDL-P Size
138...Weight Loss Exercise Niacin Fibrates Reduce Triglycerides Increase LDL-P Size
139...Exercise Weight Loss Niacin Fibrates Reduce Triglycerides Increase LDL-P Size
140...Niacin Exercise Weight Loss Fibrates Reduce Triglycerides Increase LDL-P Size
141...Statins Do Not Change Particle Size Overlooks CVD Risk TG 70 - 40
142...LDL Particle Size Measurement TG > 70 140 Assess CVD Risk
143...CVD Risk Small Dense LDL Need Measurement LDL Particle Size
144...LDL-P Measurement Needed Assess CVD When TG > 70 140
145...TG > 70 140 Direct Measurement LDL-P Size for Small Dense LDL
146...Cholesterol Essential for Life Triglycerides Deliver Energy to Muscles
147...Triglycerides Deliver Energy to Muscles Cholesterol Essential for Life
148...Diagram Compare LDL TG Dense and LDL Cholesterol Fluffy Particles
149...Genetic Variability Tolerates Different Dietary Content
150...Carbohydrate/sugar Diet Cause Dangerous Small Dense LDL Particles
151...Exercise Lowers Triglycerides Strengthens Cardiovascular Function
152...Triglycerides Eggs Decrease Improve Control Arterialsclorosis Risk
153...HDL Eggs Increase Quantity Quality Control Arterialsclorosis Risk
154...Arterialsclorosis CVD Risk Eggs Increase HDL Function Triglycerides Lower
155...Eggs HDL Rise Triglycerides Decrease Improve Control CVD Risk
156...LDL Pattern A > 250 AN LDL Pattern B 250 AN Penetrate Endothelial Lining Artery
157...HDL Particle Count Increased with Exercise Lowers CVD Risk
158...CVD Risk Requires Measuring HDL Particle Count with NMR Testing
159...Exercise HDL Particle Count Decrease Lowers CVD Risk
160...HDL Exercise Increase Particle Count Lowers CVD Risk
161...Medication Raises HDL Cholosterol But Not HDL Particle Count
162...HDL Large Particle Size Lowers CVD Risk
163...HDL Very Large Particle Size Increases CVD Risk
164...Regression Arterialsclerosis Occurs with Lower LDL and Higher HDL
165...Arterialsclerosis Regression Occurs with Lower LDL and Higher HDL
........Rapid regression of atherosclerosis:
166...CT & Intravasuclar Ultrasonography IVUS Quantify Arterial Plaque Change
167...IVUS Intravasuclar Ultrasonography CT & Quantify Arterial Plaque Change
168...Regression Atherosclerosis Measure Plauqe with CT and IVUS Technology
169...Atherosclerosis Regression Measure Plauqe with CT and IVUS Technology
170...Regression Arterialsclerosis Plaque 6.8% Rosuvastatin High Dose 18 Months
171...Statin High Dose 18 Months Lower LDL-C 60 and > 50% Reduce Plaque 6.8%
172...Rapid Regression Atherosclorotic Plaques Elevated HDL and EPCs
173...Regression Atherosclerosis Plaque Caused By Elevation HDL and Lower LDL
174...HDL Elevation and Lower LDL Could Cause Rapid Atherosclerosis Plaque Regression
175...Atherosclerosis Plaque Regression Caused By HDL Elevation and Lower LDL Could
176...Regression Arterialsclorosis Plaque Occurs Lower LDL-P Increased HDL
177...Prevention Reversal Atherosclerosis Plaque
178...Regression Atherosclerosis Plaque Prevention
179...Atherosclerosis Regression Plaque Prevention
........The prevention and regression of atherosclerotic plaques: emerging treatments
180...Atherosclerosis Test Imaging Intravascular Ultrasound IVUS
181...IVUS Intravascular Ultrasound Atherosclerosis Test Imaging
182...Atherosclerosis Test Imaging Carotid Artery Intimal-Medial Thickness CIMT
183...CIMT Carotid Artery Intimal-Medial Thickness Atherosclerosis Test Imaging
184...Exercise Vigorous 150 Minutes Moderate 75 Minutes Per Week - AHA
185...Weight Loss Increases HDL Lowers Blood Pressure Aided Exercise
186...Exercise Weight Loss Aids HDL Increase and Lowers Blood Pressure
187...Exercise Lowers Triglycerides LDL-P Apo B Increases HDl Decrease Plaque
188...Atorvastatin 80 Ezetimibe 10 Yield Atherosclerosis Regression 0.4%
189...Triglycerides Lower Endurance Exercise Increase HDL
190...Endurance Exercise Increase HDL Lowers Triglycerides
191...Exercise HDL Increase Triglyceride Lower Endurance Training
192...HDL Increase Endurance Exercise Lowers Triglycerides
193...Hypoalphalipoproteinemia - Low HDL 35
194...HDL Low Biggest Risk CVD CAD Heart Attack
195...VA HDL Intervention Study Found HDL Strongest Protection Against CVD
196...Exercise Genetic Requirement Human Cardiovascular Survival
197...Endurance Exercise Effects Cardiovascular Endothelial Function
198...Exercise Recovery Cardiovasular Disease Endothelial Function
199...Cardiovasular Disease Exercise Recovery Endothelial Function
200...Atherosclerosis Regression EPCs Increase Exercise Signals Bone Marrow
201...Regression Atherosclerosis EPCs Increase Exercise Signals Bone Marrow
202...EPCs Produced Bone Marrow Increased Exercise Repair Endothelial Lining
203...Exercise Causes Atherosclerosis Regression for Endurance Training
204...Endothelial Cells Regression Atherosclerosis Integrated HDL Effects
205...HDL EPC Elevated Causes Rapid Regression Atherosclerosis
206...EPC HDL Elevated Causes Rapid Regression Atherosclerosis
207...Atherosclerosis Elevated HDL EPC Causes Rapid Regression
........An integrated approach for the mechanisms responsible for
........atherosclerotic plaque regression
208...HDL Controversy Drug Induced Fails Regress Atherosclerosis Plaque
209...Controversy HDL Drug Induced Fails Regress Atherosclerosis Plaque
........Raising HDL Cholesterol: The Controversy
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1...What about CT test to assess level of plaque build up due to LDL 249,
2...What causes plaque "rupture" mentioned in last sentence of this para?
VA Commend Great Care Recover CABG 4x Heart Surgery 091022 Prevent C
0803 - ..
0804 - Summary/Objective
080501 - Follow up ref SDS 44 0000. ref SDS 41 0000.
080504 - [On 131210 received letter from Doctor Alba asking about
080505 - progress taking Atorvastatin 40 mg, and requesting
080506 - submission of pending issues for next meeting. ref SDS 46
080507 - HY6O
080509 - ..
080510 - [On 131216 0028 letter to Doctor Alba and medical team
080511 - submits pending issues to discuss during meeting on 131219,
080512 - ref SDS 47 8N50, and lists TG/HDL-C ratio and LDL-P issues.
080513 - ref SDS 47 6T49
080515 - ..
080516 - [On 140203 1147 blood test at Labcorp 2 days earlier on
080517 - 140201- lab report shows LDL-P 861 and LDL-C 81, TG 68, HDL
080518 - 61 - best lab ever. ref SDS 54 IM3N Lab at VA shows better
080519 - results with TG 47 HDL 58 computes to LDL-P 626.
080520 - ref SDS 54 4Z66 Results achieved hiking 933 miles since
080521 - 131015, weight dropped to 165, low-carb diet with orange
080522 - juice and Chia seeds, and taking Atorvastatin 40 mg 4
080523 - weeks, then Atorvastatin 10 mg + Ezetimibe 10 mg 4 weeks
080524 - for total Atorvastatin 1840 mg and Ezetimibe 330 mg.
080525 - ref SDS 54 I17G
080527 - ..
080528 - [On 151019 0930 Radiology report on CCTA test performed on
080529 - 151019, indicates calcification in original bypassed
080530 - arteries has increased since CABG +4 surgery on 091022;
080531 - seems conflicting with this research theorizing
080532 - atherosclerosis plaques regress rapidly with elevated HDL
080533 - and EPCs. ref SDS 69 J14N
080535 - ..
080536 - [On 151019 0930 an undated addendum was added to report
080537 - on CCTA test on 151019, that clarifies findings and
080538 - impressions by establishing CCTA found no evidence of
080539 - plaque, stenosis, occlusion of any kind or amount.
080540 - ref SDS 69 SU4L
080545 - ..
0808 - Background
081001 - Lab on 131015, showing cholesterol remained high, 131015 0724,
081002 - ref SDS 38 BE6O, conflict with increased exercise and weight loss,
081003 - discussed in the letter to the medical team yesterday on 131016 1632.
081004 - ref SDS 39 IW57
081006 - ..
081007 - On 131017 1000 VA medical chart Progress Notes assessment report
081008 - patient status CAD stable, asymptomatic. hyperlipidemia not
081009 - controlled. ref SDS 40 T24N
081011 - ..
081012 - On 131017 1000 Doctor Egan proposed referring patient for clinical
081013 - trial to reduce cholesterol with new "targeted" drugs. ref SDS 40 179N
081015 - ..
081016 - On 131017 1000 VA medical chart Progress Notes assessment report
081017 - patient status hyperlipidemia not controlled, ref SDS 40 PSXT; Doctor
081018 - Egan makes referral to SF VA Medical Center for consult on
081019 - participation clinical trials, ref SDS 40 EU9F, with experimental
081020 - agents such as AMG 145 and REGN 727 to resolve multiple statin
081021 - intolerances. ref SDS 40 CN4H
081023 - ..
081024 - On 131103 received letter from VA SF Medical Center scheduling meeting
081025 - on 131121 1000, to consider clinical trial for lowering cholesteral.
081026 - ref SDS 41 YT4N
081028 - Thursday November 21, 2013 1000 METAB-FELLOW-THRUSDAY Clinic
081030 - ..
081031 - On 131112 New York Times published several articles reporting that the
081032 - day before on 131113, American Heart Association published new
081033 - guidelines for treating CAD patients that expand use of statin
081034 - medication regardless of cholesterol levels, ref SDS 42 0001, and
081035 - further raise the LDL 70 to LDL 190, as a target for cardiovascular
081036 - risk. ref SDS 42 CW6H
081038 - ..
081039 - On 131114 New York Times published several articles reporting that the
081040 - day before on 131113, American Heart Association published new
081041 - guidelines for treating CAD patients. ref SDS 43 SH6G
081043 - ..
081044 - On 131121 1000 meeting with Doctor Diana Alba, Va San Francisco
081045 - Medical Center prescribes Atorvastatin 10 MG 4 weeks. ref SDS 44 HY6O
081047 - ..
081048 - On 131121 1000 at 1125 meeting with Karen and Doctor Shunk, Va San
081049 - Francisco Medical Center seemed to support Doctor Alba's prescription
081050 - for Atorvastatin 10 MG 4 weeks; further suggested trying Chia seeds to
081051 - lower cholesterol without medication. ref SDS 44 MS7G
081057 - ..
0813 - Progress ref SDS 0 MN98
081401 - Hyperlipidemia Not Controlled Cholesterol Elevated Despite Exercise
081402 - Cholesterol Elevated Despite Exercise Discuss Clinical Trial
081403 - Clinical Trial Considered Lower Cholesterol Without Statin Drugs
081405 - Follow up ref SDS 44 HY6O, ref SDS 41 VY6H.
081407 - Submitted letter to Karen saying...
081409 - 1. Subject: VA Excellent Care Post CABG x4
081410 - Date: Mon, 25 Nov 2013 01:04:55 -0800
081419 - ..
081420 - 2. Thanks for meeting briefly in your office with Doctor Shunk,
081421 - this past Thursday on 131121. ref SDS 44 MS7G
081426 - ..
081427 - 3. It's always a pleasure to thank the VA SF Medical Center for
081428 - great care, beginning with your timely, thorough coordination.
081429 - Doctor Shunk and his Cath Lab team provided critical guidance
081430 - on 091021. I'm still amazed that Dennis arranged on moment's
081431 - notice to play Simon and Garfunkel's famous album from the 70s,
081432 - while Doctor Shunk explained... "Rod, let me show you what I'm
081433 - seeing here." It's a wonderful story for the VA. [...reported
081434 - on 091021 0716. ref SDS 4 025B
081436 - ..
081437 - 4. Thanks for reporting and congratulations to Doctor Tseng taking
081438 - over for Doctor Ratcliffe, as Chief of Surgery. [...reported on
081439 - 131121 0930. ref SDS 44 NQ31...]. They were both instrumental
081440 - in my surgery on 091022, ref SDS 5 PQWU, leading the
081441 - Cardiothoracic team - Neal, Paula, KC, Joe and others.
Lipids Triglycerides TG Rise HDL Declines CAD CVD Risk Rises Conflic
310401 - ..
310402 - Lipid Lab LDL HDL TG Conflicts Hiking Weight Loss
310403 - Lab Lipid LDL HDL TG Conflicts Hiking Weight Loss
310404 - Cholesterol Elevated Despite Exercise Weight Loss
310405 - Hyperlipidemia Not Controlled Cholesterol Elevated Despite Exercise
310408 - 5. Doctor Egan's Progress Notes on 131017, report the patient has
310409 - made a strong recovery from CABG, under his guidance at the
310410 - Martinez Clinic, ref SDS 40 UU7J, underscored by climbing Half
310411 - Dome a few weeks ago on 130918. ref SDS 37 0001
310413 - ..
310414 - 6. This reflects increased exercise, since surgery in 2009. If
310415 - time permits, you can see patient history on diet medication
310416 - exercise and vitals the past 2 years, that shows hiking 14.2
310417 - miles per day for 3 days last week, and completed with 11 mile
310418 - dailies including today. [...see case study on 120101 0900.
310419 - ref SDS 15 L25L
310421 - ..
310422 - 7. Yesterday, I did my fastest time ever [...160 minutes...] for
310423 - 11 miles. ref SDS 15 8A9A
310425 - [On 120101 case study show on 131223 did 11 mile route in
310426 - 159 minutes - best time ever. ref SDS 15 839G
310428 - ..
310429 - 8. At this time, I feel very healthy and functional.
310431 - ..
310432 - 9. Before meeting with you and Doctor Shunk, I met with Doctor
310433 - Diana Alba in the Metab-Fellow-Thursday Clinic. ref SDS 44 6H6K
310434 - She is listed with the UCSF Dep of Medicine, Division of
310435 - Endoncrinology and Metabolism. The meeting was arranged by
310436 - Doctor Egan to begin a process finding a clinical trial or
310437 - other path for reducing risks of hyperlipidemia, with LDL 249
310438 - in the lab on 131015. ref SDS 38 BE6O
310440 - [...below on 131125 0005 at 1516 receive letter from Karen
310441 - saying she will contact UCSF for clinical trials on
310442 - lowering cholesterol. ref SDS 0 V163
310444 - ..
310445 - [...below on 131125 0005 at 1923 follow letter to Karen
310446 - notifies VA SF Medical Center patient objective to find
310447 - clinical trials or other means that reduce risk of
310448 - arterialsclorosis without using statin medications.
310449 - ref SDS 0 YU5X
310451 - ..
310452 - 10. You can see patient history on the lipid panel going back to
310453 - 2006, there appears to be inverse correlation between healthy
310454 - diet, rising aerobic exercise 200-350 miles per month, and
310455 - rising LDL. ref SDS 38 BE9O
310457 - ..
310458 - 11. In 2006, I was hiking 50 miles per month; by 2009, I increased
310459 - this to about 100 miles per month, yet still weighed 205.
310460 - During that period without medication, cholesterol fell from
310461 - LDL 192 to LDL 164. In 2010, Doctor Sandhu, Primary Care in
310462 - the Martinez Clinic initiated treatment with Simvastatin,
310463 - applying CAD protocol [...reported on 100104 0930. ref SDS 7
310464 - FG6K...]. LDL dropped to 96 [...after doubling dose to 40 mg,
310465 - reported on 100721 0800. ref SDS 8 RP4F...], but then
310466 - increased back to over 200 [...reported on 111117 1415.
310467 - ref SDS 14 2A4G...], i.e., doubled, while causing severe
310468 - myopathy in the left shoulder. Doctor Egan in Cardiology
310469 - continued Simvastatin, but then switched to Rosuvastatin to
310470 - avoid side effects, and to try lowering cholesterol to below
310471 - LDL 70. [...reported on 110817 1030. ref SDS 13 DG36...],
310473 - ..
310474 - 12. As Doctor Egan reports on 131017, ref SDS 40 E47G, severe side
310475 - effects required ending Rosuvastatin on 121206, see line
310476 - 100401. ref SDS 25 I05F
310478 - ..
310479 - 13. Increased hiking the past year to 200-350 miles per month has
310480 - reduced weight about 30 pounds to 170. [...see patient history
310481 - hiking 11 miles per day 7 days a week, beginning on 130427,
310482 - shown in patient history referenced above in para 6,
310483 - ref SDS 0 UK42, case study on 120101 0900. ref SDS 15 F35N...].
310484 - Still working on getting to 165 or possibly 160. Have reached
310485 - 167 numerous times, but have not held that number.
310487 - [On 131216 0028 letter notified VA again that hiking
310488 - increased to 11 miles per day, ref SDS 48 6T49, citing
310489 - patient history, beginning on 130427, in case study on
310490 - 120101 0900. ref SDS 15 F35N
310492 - ..
310493 - 14. Since cholesterol has increased, instead of declined as
310494 - expected from increasing exercise and weight loss by orders of
310495 - magnitude, this presents a question of why it was much lower
310496 - previously with much less exercise and higher weight and no
310497 - medication? Is this is common from merely aging 7 years? If
310498 - so, then it might be reasonable to risk severe adverse side
310499 - effects taking medication in order to lower LDL.
310501 - ..
310502 - 15. Otherwise, might there be tests to determine what is causing
310503 - LDL to rise, when it should be falling, and similarly, HDL is
310504 - falling, when it should be rising, based on patient history of
310505 - hiking 200-350 miles per month and weight loss of 30 pound the
310506 - past 6 months or so?
310508 - [On 140203 1147 blood test at Labcorp 2 days earlier on
310509 - 140201- lab report shows LDL-P 861 and LDL-C 81, TG 68, HDL
310510 - 61 - best lab ever. ref SDS 54 IM3N Lab at VA shows better
310511 - results with TG 47 HDL 58 computes to LDL-P 626.
310512 - ref SDS 54 4Z66 Results achieved hiking 933 miles since
310513 - 131015, weight dropped to 165, low-carb diet with orange
310514 - juice and Chia seeds, and taking Atorvastatin 40 mg 4
310515 - weeks, then Atorvastatin 10 mg + Ezetimibe 10 mg 4 weeks
310516 - for total Atorvastatin 1840 mg and Ezetimibe 330 mg.
310517 - ref SDS 54 I17G
310519 - ..
310520 - 16. Could excessive exercise be stimulating production of
310521 - cholesterol? Could past medications have caused damage that is
310522 - making cholesterol rise in conflict with patient history?
310524 - ..
310525 - 17. During discussion in your office on 131121, there was an
310526 - observation that the patient is simply unlucky having high
310527 - cholesterol that does not decline with increased exercise and
310528 - weight loss. Perhaps so, but this is not evident from patient
310529 - history beginning in 2006, as shown in the Lipid chart on
310530 - 131015? ref SDS 38 BE9O
310532 - [...below on 131125 0005 research found representation that
310533 - increasing cholesterol with increased exercise indicates
310534 - body malfunction of liver that requires remedy to restore
310535 - normal production of cholesterol by the liver. ref SDS 0
310536 - VT41
310538 - ..
310539 - [On 140203 1147 blood test at Labcorp 2 days earlier on
310540 - 140201- lab report shows LDL-P 861 and LDL-C 81, TG 68, HDL
310541 - 61 - best lab ever. ref SDS 54 IM3N Lab at VA shows better
310542 - results with TG 47 HDL 58 computes to LDL-P 626.
310543 - ref SDS 54 4Z66 Results achieved hiking 933 miles since
310544 - 131015, weight dropped to 165, low-carb diet with orange
310545 - juice and Chia seeds, and taking Atorvastatin 40 mg 4
310546 - weeks, then Atorvastatin 10 mg + Ezetimibe 10 mg 4 weeks
310547 - for total Atorvastatin 1840 mg and Ezetimibe 330 mg.
310548 - ref SDS 54 I17G
310551 - ..
310552 - Wicked Problems Good Condition Hiking Weight Loss Masks Poor Health
310553 - Good Condition False Positive Hiking Weight Loss Masks Poor Health
310554 - Hiking Good Condition Masks Poor Health CVD with High LDL-P
310555 - False Positive Patient Good Condition Hiking Masks Rising CVD
310558 - 18. I am concerned that seemingly excellent health shown by rising
310559 - physical capacity may be a false positive, masking failing
310560 - health due to rising arteriosclerosis. Prior to CABG in 2009,
310561 - I had minor chest pains beginning in 2003, that only occurred
310562 - when hiking up the first hill at Lafayette reservoir on a
310563 - 3-mile route. When one day minor pain persisted for an entire
310564 - lap, this signal was reported to Doctor Lee, then in Martinez
310565 - EGD Dep, who made referral to Doctor Egan in Cardiology.
310566 - Since, surgery in 2009, and particularly the past 12 months,
310567 - there has been no inkling of chest pain of any kind, and the
310568 - body is placed under severe duress for 3 plus hours 7 days a
310569 - week.
310571 - [...below on 131125 0005 research found patient with high
310572 - LDL 249 was "healthy" with low risk for arterialsclorosis
310573 - CVD because HDL > 50 and triglycerides < 100 so TG/HDL
310574 - ratio below 2, indicating LDL particle size is "protective"
310575 - because it is "large and fluffy" that cannot penetrate
310576 - endothelial lining of artery walls. ref SDS 0 6P4N
310578 - ..
310579 - [On 140116 0814 letter to medical team cites research that
310580 - seems to indicate labs can be ordered to test patients for
310581 - discordance between high LDL-C and low LDL-P that presents
310582 - lowest risk for arterialsclorosis, CVD, mycardial
310583 - infarction. ref SDS 52 FW4K
310585 - ..
310586 - [On 140203 1147 blood test at Labcorp 2 days earlier on
310587 - 140201- lab report shows LDL-P 861 and LDL-C 81, TG 68, HDL
310588 - 61 - best lab ever. ref SDS 54 IM3N Lab at VA shows better
310589 - results with TG 47 HDL 58 computes to LDL-P 626.
310590 - ref SDS 54 4Z66 Results achieved hiking 933 miles since
310591 - 131015, weight dropped to 165, low-carb diet with orange
310592 - juice and Chia seeds, and taking Atorvastatin 40 mg 4
310593 - weeks, then Atorvastatin 10 mg + Ezetimibe 10 mg 4 weeks
310594 - for total Atorvastatin 1840 mg and Ezetimibe 330 mg.
310595 - ref SDS 54 I17G
310597 - ..
310598 - [On 140204 1236 VA letter maintains patient lab on 131015
310599 - showing LDL-C 249, and calculated non-HDL 271 represent
310600 - "unhealthy" lipid profile for patient with history of
310601 - coronary artery disease/cardiovascular disease (CAD/CVD).
310602 - ref SDS 56 6U4L This assesement aligns with NMR test
310603 - showing range for non-HDL
310606 - ..
310607 - 19. If the patient foregoes statin treatment at this time in order
310608 - to avoid side effects, might it be expected to get similar
310609 - notice over the next 6 years that build up in the arteries is
310610 - occurring that may cause a blockage, as occurred during 2003 -
310611 - 2009? In other words, if treatment with statins had been
310612 - started in 2003, and if that was effective, would it have
310613 - likely prevented needing CABG surgery on 091022? If so, is it
310614 - reasonable now to continue subjecting the body to high duress,
310615 - and defer medication until minor symptoms begin, as occurred
310616 - previously in 2003?
310618 - [...below on 131125 0005 CT imaging can determine presence
310619 - of arterialsclorosis plaque in the circulatory system, and
310620 - measure progression toward blockage. ref SDS 0 N73K and
310621 - summarized. ref SDS 0 278M
310623 - ..
310624 - 20. Maybe a study could be done to test the theory that increasing
310625 - exercise increases tolerance for cholesterol, even at elevated
310626 - levels, as in this case. We have 4 years without symptoms,
310627 - much with elevated cholesterol. Would the medical team feel
310628 - the patient is at too great a risk to try for another 4 years?
310630 - [...below on 131125 0005 research indicates high LDL lipid
310631 - test results, like LDL 249 in lab on 131015 0724,
310632 - ref SDS 38 BE6O, are well tolerated and even healthy, if
310633 - discordant, ref SDS 0 OB7L, with LDL-P < 1000, ref SDS 0
310634 - K68N, if LDL particle size is large, and this occurs when
310635 - triglycerides < 100 and HDL > 50, ref SDS 0 338N; exercise
310636 - increases HDL, ref SDS 0 W76M, and lowers triglycerides.
310637 - ref SDS 0 QP9F
310639 - ..
310640 - [On 140116 0814 letter to medical team cites research that
310641 - seems to indicate labs can be ordered to test patients for
310642 - discordance between high LDL-C and low LDL-P that presents
310643 - lowest risk for arterialsclorosis, CVD, mycardial
310644 - infarction. ref SDS 52 FW4K
310646 - ..
310647 - [On 140203 1147 blood test at Labcorp 2 days earlier on
310648 - 140201- lab report shows LDL-P 861 and LDL-C 81, TG 68, HDL
310649 - 61 - best lab ever. ref SDS 54 IM3N Lab at VA shows better
310650 - results with TG 47 HDL 58 computes to LDL-P 626.
310651 - ref SDS 54 4Z66 Results achieved hiking 933 miles since
310652 - 131015, weight dropped to 165, low-carb diet with orange
310653 - juice and Chia seeds, and taking Atorvastatin 40 mg 4
310654 - weeks, then Atorvastatin 10 mg + Ezetimibe 10 mg 4 weeks
310655 - for total Atorvastatin 1840 mg and Ezetimibe 330 mg.
310656 - ref SDS 54 I17G
310658 - ..
310659 - 21. Initially, this question seems resolved from patient history of
310660 - failing, i.e., needing surgery with relatively low levels of
310661 - cholesterol - LDL below 300. However, prior failure occurred
310662 - hiking only 100 miles per month, and weighing 200+. Now,
310663 - hiking is at 200-350 miles per month, and weight is 170 after a
310664 - hike - does the medical team view this as a material change?
310665 - If we increased to 400 miles per month, would that make a
310666 - difference sufficient to avoid taking medication with severe
310667 - adverse side effects?
310669 - ..
310670 - Research indicates high LDL-C cholesterol per se does not cause
310671 - arterialsclorsis - coronary artery disease (CAD) - cardio vascular
310672 - disease CVD). For example, Jim Fixx, a public voice for aerobic
310673 - running exercise, died on the side of the road on 1984 July 20, due to
310674 - CVD while running 10 miles daily. Further, low LDL below 70 is not
310675 - sufficient to maintain cardio vascular health.
310677 - ..
310678 - [...below on 131125 0005 Tim Russert died with CVD despite
310679 - LDL < 70, but HDL < 40. ref SDS 0 W26M
310681 - ..
310682 - [On 140203 1147 blood test at Labcorp 2 days earlier on
310683 - 140201- lab report shows LDL-P 861 and LDL-C 81, TG 68, HDL
310684 - 61 - best lab ever. ref SDS 54 IM3N Lab at VA shows better
310685 - results with TG 47 HDL 58 computes to LDL-P 626.
310686 - ref SDS 54 4Z66 Results achieved hiking 933 miles since
310687 - 131015, weight dropped to 165, low-carb diet with orange
310688 - juice and Chia seeds, and taking Atorvastatin 40 mg 4
310689 - weeks, then Atorvastatin 10 mg + Ezetimibe 10 mg 4 weeks
310690 - for total Atorvastatin 1840 mg and Ezetimibe 330 mg.
310691 - ref SDS 54 I17G
Atorvastatin 40 MG Started 4-week Trial Test Side Effects Before Add
550401 - ..
550402 - Atorvastatin Prescribed with Ezetimibe Increase HDL Lower Triglycerides
550403 - Hyperlipidemia Clinical Trials Resolve Non-statin Drugs Investigations
550404 - Clinical Trials Resolve Hyperlipidemia Non-statin Drugs Investigations
550405 - Investigations Clinical Trials Resolve Hyperlipidemia Non-statin Drugs
550408 - Letter to medical team continues...
550410 - 22. On Thursday, 131121, Doctor Alba prescribed taking Atorvastatin
550411 - for 4 weeks, and then meet again to evaluate continuing or
550412 - trying other non-statin drugs, which she will be researching,
550413 - including clinical trials. She cited contacts at UCSF. During
550414 - the meeting in your office, Doctor John Kane was suggested for
550415 - consulting in this case, since he is the Director of the Adult
550416 - Lipid Clinic at UCSF.
550418 - ..
550419 - 23. I assume Doctor Alba and her team will order a lab in 4 weeks
550420 - to evaluate results taking Atorvastatin. By chance, I saw
550421 - Doctor Egan briefly at the Martinez VA Clinic on Friday, and
550422 - related meetings the day before at the Medical Center in San
550423 - Francisco. Explained progress and planning by Doctor Alba to
550424 - investigate clinical trials without statins.
550426 - [...below on 131125 0005 research finds ezetimibe (zetia)
550427 - for secondary drug recommended by "expert" to treat high
550428 - risk CAD patient, ref SDS 0 XG4N, where LDL-P is high and
550429 - discordant with low LDL-C, approximated by TG/HDL-C ratio <
550430 - 2, ref SDS 0 QS9F, which is shown by evidence in this case
550431 - from lab on 131015 0724. ref SDS 38 BE6O
550433 - ..
550434 - 24. To implement Doctor Alba's plan, I began taking Atorvastatin 40
550435 - mg Thursday evening, shown in patient history in case study on
550436 - 120101. ref SDS 15 0001
550438 - [On 140203 1147 blood test at Labcorp 2 days earlier on
550439 - 140201- lab report shows LDL-P 861 and LDL-C 81, TG 68, HDL
550440 - 61 - best lab ever. ref SDS 54 IM3N Lab at VA shows better
550441 - results with TG 47 HDL 58 computes to LDL-P 626.
550442 - ref SDS 54 4Z66 Results achieved hiking 933 miles since
550443 - 131015, weight dropped to 165, low-carb diet with orange
550444 - juice and Chia seeds, and taking Atorvastatin 40 mg 4
550445 - weeks, then Atorvastatin 10 mg + Ezetimibe 10 mg 4 weeks
550446 - for total Atorvastatin 1840 mg and Ezetimibe 330 mg.
550447 - ref SDS 54 I17G
550449 - ..
550450 - 25. Doctor Alba said she would submit a letter confirming her work
550451 - plan. I gave her my email address, but so far have not
550452 - received her letter - maybe the address was quickly scribbled
550453 - incorrectly or misplaced. We were rushed on Thursday. Can you
550454 - please facilitate communication by forwarding this letter to
550455 - Doctor Alba with a copy to me confirming the work plan?
550457 - ..
550458 - 26. Doctor Alba may have prescribed Atorvastatin 10 mg, or 20 mg.
550459 - I have 40 mg pills on hand, and so started with them to test if
550460 - this will move the numbers in 4 weeks. I seem to remember one
550461 - of the side effects is "confusion and memory loss," but am not
550462 - sure, so treatment may already be taking affect (hopefully,
550463 - just joking). In any case, Doctor Alba's letter will nail
550464 - down all instructions, eliminating confusion, regardless of
550465 - memory loss.
550467 - ..
550468 - 27. While this is a long letter, the short story is that the VA has
550469 - been outstanding providing care and working with the patient to
550470 - enjoy a high quality of life.
550472 - ..
550473 - 28. Happy holidays to all,
Atorvastatin 10 MG 4-week Trial VA Treatment Plan Test Side Effects
8604 - 1516
860501 - ..
860502 - Work Plan Atorvastan 4-week Trial then Add Ezetimibe
860503 - Karen Coordinated Communications Starting Trial Atorvastatin
860506 - Received letter from Karen saying...
860508 - 1. Subject: RE: VA Excellent Care Post CABG x4
860509 - Date: Mon, 25 Nov 2013 14:39:29 -0800
860513 - ..
860514 - 2. Hello Rod,
860516 - I could not find Dr Albas email, so I forwarded your letter to
860517 - her attending so that he can forward it to her. This was the
860518 - plan.
860520 - [...below on 131125 0005 at 1702 received letter from
860521 - Doctor Alba. ref SDS 0 I67O
860523 - ..
860524 - [...below on 131125 0005 at 2006 letter responds to Karen,
860525 - reporting found Chia seeds for new dietary supplement that
860526 - may help control cholesterol, weight, and increase energy.
860527 - ref SDS 0 057E
860529 - ..
860530 - [On 131210 received letter from Doctor Alba asking about
860531 - progress taking Atorvastatin 40 mg, and requesting
860532 - submission of pending issues for next meeting. ref SDS 46
860533 - HY6O
860535 - ..
860536 - 3. Plan:
860538 - -Trial of Atorvastatin 10 mg po daily, if tolerated we can
860539 - increase to maximum dose to reach LDL goal
860541 - ..
860542 - -Start Zetia 10 mg po daily in 4 weeks.
860544 - ..
860545 - Karen's letter confirms Doctor Alba's work plan during meeting at VA
860546 - SF Medical Center on 131121 0930. ref SDS 44 6H6K
860548 - [below on 131125 0005 research finds ezetimibe (zetia) for
860549 - secondary drug recommended by "expert" to treat high risk
860550 - CAD patient, ref SDS 0 XG4N, where LDL-P is high and
860551 - discordant with low LDL-C, approximated by TG/HDL-C ratio <
860552 - 2, ref SDS 0 QS9F, which is shown by evidence in this case
860553 - from lab on 131015 0724. ref SDS 38 BE6O
860555 - ..
860556 - [On 140430 0900 letter to VA notifies some minor dizziness
860557 - has begun while taking Atorvastatin 10mg with Ezetimibe
860558 - 10mg. ref SDS 57 PU43
Atorvastatin 10 MG 4-week Trial VA Treatment Plan Test Side Effects
AK0401 - ..
AK0402 - Clinical Trial PCSK9 VA Conctact UCSF Resolve Hyperlipidemia
AK0405 - Karen's letter continues...
AK0407 - -Regarding medical trial- PCSK9 is not available at this time,
AK0408 - but I will contact UCSF to determine if there are any ongoing
AK0409 - trials for lipid lowering medications and to see if Mr Welch
AK0410 - could participate in any of them.
AK0412 - ..
AK0413 - Very helpful for Karen to make inquiries for trials to lower lipids,
AK0414 - requested in the letter to Karen earlier this morning, and with copy
AK0415 - to Doctor Alba, shown above. ref SDS 0 UK59
AK0417 - [...below on 131125 0005 at 1923 follow up letter to Karen
AK0418 - notifies VA SF Medical Center patient objective to find
AK0419 - clinical trials or other means that reduce risk of
AK0420 - arterialsclorosis without using statin medications.
AK0421 - ref SDS 0 YU5X
Atorvastatin 10 MG Ezetimibe Zeita 10 MB Research Lowers Hyperlipide
B90401 - ..
B90402 - Ezetimibe (Zetia) with Atorvastatin Promising Lower CVD Risk Hyperlipidemia
B90403 - Atorvastatin with Ezetimibe (Zetia) Promising Lower CVD Risk Hyperlipidemia
B90405 - Research shows Zetia has been used successfully combined with
B90406 - Atvorstatin, shown in paper at...
B90408 - American Journal of Cardiology
B90409 - Volume 105, Issue 5 , Pages 656-663, 1 March 2010
B90411 - ..
B90412 - Safety and Efficacy of Ezetimibe Added to Atorvastatin Versus
B90413 - Up Titration of Atorvastatin to 40 mg in Patients >=65 Years
B90414 - of Age (from the ZETia in the ELDerly [ZETELD] Study)
B90416 - http://www.ajconline.org/article/S0002-9149(09)02552-1/abstract
B90418 - ..
B90419 - Few clinical studies have focused on the efficacy of
B90420 - lipid-lowering therapies in patients >=65 years of age.
B90421 - The percentage of change from baseline in low-density
B90422 - lipoprotein (LDL) cholesterol and the percentage of
B90423 - patients achieving prespecified LDL cholesterol levels
B90424 - after 12 weeks of ezetimibe 10 mg plus atorvastatin versus
B90425 - up titration of atorvastatin were assessed in subjects ?65
B90426 - years old with hyperlipidemia and at high risk of coronary
B90427 - heart disease.
B90429 - ..
B90430 - After stabilization of atorvastatin 10-mg therapy, 1,053
B90431 - patients, >= 65 years old, at high risk of coronary heart
B90432 - disease, with and without atherosclerotic vascular disease
B90433 - and a LDL cholesterol level that was not <70 or <100 mg/dl,
B90434 - respectively, were randomized to receive ezetimibe added to
B90435 - atorvastatin 10 mg for 12 weeks versus up titration to
B90436 - atorvastatin 20 mg for 6 weeks followed by up titration to
B90437 - atorvastatin 40 mg for an additional 6 weeks.
B90439 - ..
B90440 - Ezetimibe added to atorvastatin 10 mg resulted in
B90441 - significantly greater changes at week 6 in LDL cholesterol
B90442 - (p <0.001), significantly more patients with
B90443 - atherosclerotic vascular disease achieving a LDL
B90444 - cholesterol level of <70 mg/dl (p <0.001), and
B90445 - significantly more patients without atherosclerotic
B90446 - vascular disease achieving a LDL cholesterol level of <100
B90447 - mg/dl (p <0.001) at weeks 6 and 12 compared to atorvastatin
B90448 - 20 mg or atorvastatin 40 mg.
B90450 - ..
B90451 - In addition, ezetimibe plus atorvastatin 10 mg resulted in
B90452 - significantly greater changes at week 6 in total
B90453 - cholesterol, triglycerides, non-high-density lipoprotein
B90454 - (HDL) cholesterol, apolipoprotein B (all p <0.001), and HDL
B90455 - cholesterol (p = 0.021) compared with atorvastatin 20 mg
B90456 - and significantly greater changes at week 12 in LDL
B90457 - cholesterol, non-HDL cholesterol, apolipoprotein A-I (p =
B90458 - 0.001), total cholesterol, apolipoprotein B (p <0.030), and
B90459 - HDL cholesterol (p <0.001) compared with atorvastatin 40
B90460 - mg. Both treatments were generally well tolerated, with
B90461 - comparable safety profiles.
B90463 - [On 140430 0900 letter to VA notifies some minor
B90464 - dizziness has begun while taking Atorvastatin 10mg with
B90465 - Ezetimibe 10mg. ref SDS 57 PU43
B90467 - ..
B90468 - [below on 131125 0005 research finds ezetimibe (zetia)
B90469 - for secondary drug recommended by "expert" to treat high
B90470 - risk CAD patient, ref SDS 0 XG4N, where LDL-P is high
B90471 - and discordant with low LDL-C, approximated by TG/HDL-C
B90472 - ratio < 2, ref SDS 0 QS9F, which is shown by evidence in
B90473 - this case from lab on 131015 0724. ref SDS 38 BE6O
B90475 - ..
B90476 - In conclusion, adding ezetimibe to atorvastatin 10 mg
B90477 - produced significantly greater favorable changes in most
B90478 - lipids at 6 and 12 weeks and significantly greater
B90479 - attainment of prespecified LDL cholesterol levels than
B90480 - doubling or quadrupling the atorvastatin dose in patients
B90481 - >=65 years old at high risk for coronary heart disease.
B90483 - ..
B90484 - [On 120101 0900 received prescription for Ezetimibe, so
B90485 - begin trial Atorvastatin 10 mg and Ezetimite 10 mg to
B90486 - manage cholesterol. ref SDS 15 6A6H
B90488 - ..
B90489 - [On 140203 1147 blood test at Labcorp 2 days earlier on
B90490 - 140201- lab report shows LDL-P 861 and LDL-C 81, TG 68,
B90491 - HDL 61 - best lab ever. ref SDS 54 IM3N Lab at VA shows
B90492 - better results with TG 47 HDL 58 computes to LDL-P 626.
B90493 - ref SDS 54 4Z66 Results achieved hiking 933 miles since
B90494 - 131015, weight dropped to 165, low-carb diet with orange
B90495 - juice and Chia seeds, and taking Atorvastatin 40 mg 4
B90496 - weeks, then Atorvastatin 10 mg + Ezetimibe 10 mg 4 weeks
B90497 - for total Atorvastatin 1840 mg and Ezetimibe 330 mg.
B90498 - ref SDS 54 I17G
B90502 - ..
B90503 - Another article shows...
B90505 - AHA
B90506 - American Heart Association
B90507 - Circulation.
B90508 - 2003; 107: 2409-2415
B90509 - Published online before print April 28, 2003,
B90510 - doi: 10.1161/?01.CIR.0000068312.21969.C8
B90512 - ..
B90513 - Received December 23, 2002; revision received February 20,
B90514 - 2003; accepted March 5, 2003.
B90516 - ..
B90517 - Clinical Investigation and Reports
B90518 - Effect of Ezetimibe Coadministered With Atorvastatin in
B90519 - 628 Patients With Primary Hypercholesterolemia
B90522 - A Prospective, Randomized, Double-Blind Trial
B90524 - https://circ.ahajournals.org/content/107/19/2409.full
B90526 - ..
B90527 - Christie M. Ballantyne, MD;
B90528 - John Houri, MD;
B90529 - Alberto Notarbartolo, MD;
B90530 - Lorenzo Melani, MD;
B90531 - Leslie J. Lipka, MD, PhD;
B90532 - Ramachandran Suresh, PhD;
B90533 - Steven Sun, PhD;
B90534 - Alexandre P. LeBeaut, MD;
B90535 - Philip T. Sager, MD;
B90536 - Enrico P. Veltri, MD;
B90537 - for the Ezetimibe Study Group
B90539 - ..
B90540 - Correspondence to Christie M. Ballantyne, MD, Baylor
B90541 - College of Medicine, 6565 Fannin Street, MS A-601,
B90542 - Houston, TX 77030. E-mail email@example.com
B90545 - 1. Abstract
B90547 - 1. Background
B90549 - Despite the established efficacy of statins, many
B90550 - patients do not achieve recommended LDL cholesterol
B90551 - (LDL-C) goals. Contributing factors may be inadequate
B90552 - dosing, increased risk for adverse effects with
B90553 - high-dose monotherapy, and increased potential for
B90554 - intolerance and adverse effects with combinations of
B90555 - available agents.
B90558 - ..
B90559 - Atorvastatin 10 Ezetimibe 10 HDL 5% Increase TG 30% LDL-C 50% Reduction
B90560 - HDL 5% Increase TG 30% LDL-C 50% Reduction Atorvastatin 10 Ezetimibe 10
B90563 - 2. Methods and Results
B90565 - In a double-blind study, 628 patients with baseline
B90566 - LDL-C 145 to 250 mg/dL and triglycerides ?350 mg/dL
B90567 - were randomly assigned to receive 1 of the following
B90568 - for 12 weeks: ezetimibe (10 mg/d); atorvastatin (10,
B90569 - 20, 40, or 80 mg/d); ezetimibe (10 mg) plus
B90570 - atorvastatin (10, 20, 40, or 80 mg/d); or placebo. The
B90571 - primary efficacy end point was percentage reduction in
B90572 - LDL-C for pooled ezetimibe plus atorvastatin versus
B90573 - pooled atorvastatin treatment groups. Ezetimibe plus
B90574 - atorvastatin significantly improved LDL-C, HDL
B90575 - cholesterol (HDL-C), triglycerides, total
B90576 - cholesterol:HDL-C, and high-sensitivity C-reactive
B90577 - protein (hs-CRP) compared with atorvastatin alone
B90578 - (P<0.01). Coadministration of ezetimibe provided a
B90579 - significant additional 12% LDL-C reduction, 3% HDL-C
B90580 - increase, 8% triglyceride reduction, and 10% hs-CRP
B90581 - reduction versus atorvastatin alone.
B90583 - ..
B90584 - Ezetimibe plus atorvastatin provided LDL-C reductions
B90585 - of 50% to 60%, triglyceride reductions of 30% to 40%,
B90586 - and HDL-C increases of 5% to 9%, depending on
B90587 - atorvastatin dose. LDL-C reductions with ezetimibe
B90588 - plus 10 mg atorvastatin (50%) and 80 mg atorvastatin
B90589 - alone (51%) were similar.
B90591 - ..
B90592 - See "Discussion" explaining Atorvastatin 10 Ezetimibe 10 achieved 50%
B90593 - redution LDL-C. ref SDS 0 MH7I
B90595 - ..
B90596 - Assume similarly, Atorvastatin 10 with Ezetimibe 10 acheved low end
B90597 - increase HDL 5%, and reduced TG 30%.
B90599 - ..
B90600 - 3. Conclusions
B90602 - Ezetimibe plus atorvastatin was well tolerated, with a
B90603 - safety profile similar to atorvastatin alone and to
B90604 - placebo. When coadministered with atorvastatin,
B90605 - ezetimibe provided significant incremental reductions
B90606 - in LDL-C and triglycerides and increases in HDL-C.
B90607 - Coadministration of ezetimibe and atorvastatin offers a
B90608 - well-tolerated and highly efficacious new treatment
B90609 - option for patients with hypercholesterolemia.
B90611 - ..
B90612 - Details of study omitted from original source...
B90614 - ..
B90615 - 4. Discussion
B90617 - Coadministration of ezetimibe with the starting dose
B90618 - (10 mg) of atorvastatin provided a 50% reduction in
B90619 - LDL-C, comparable to the 51% reduction obtained with
B90620 - high-dose (80 mg) atorvastatin. Because each doubling
B90621 - of a statin dose provides only 5% to 6% additional
B90622 - LDL-C reduction,16 the need for multiple dosage
B90623 - adjustments may limit the routine use of optimum
B90624 - statin doses in clinical practice. Statin doses are
B90625 - often not titrated to achieve recommended LDL-C
B90626 - goals,2 and at starting doses of statin therapy, most
B90627 - patients do not receive sufficient LDL-C reductions to
B90628 - reach target.
B90630 - ..
B90631 - In ACCESS overall, at initial doses, LDL-C goals were
B90632 - met in 53% of patients receiving atorvastatin, 38% of
B90633 - patients receiving simvastatin, 28% of patients
B90634 - receiving lovastatin, and 15% of patients receiving
B90635 - pravastatin or fluvastatin.3
B90637 - ..
B90638 - Even fewer patients in the highest-risk category of CHD
B90639 - can achieve the ATP goal of LDL-C <100 mg/dL: 6% to 43%
B90640 - of patients with CHD in ACCESS,3 and 1% to 32% of
B90641 - patients with documented atherosclerosis receiving
B90642 - starting doses of atorvastatin, fluvastatin,
B90643 - lovastatin, or simvastatin.18 In ATP III, this
B90644 - highest-risk category has been expanded to include
B90645 - individuals with noncoronary atherosclerosis, diabetes
B90646 - mellitus, and multiple risk factors conferring 10-year
B90647 - CHD risk >20%, doubling the number of individuals with
B90648 - this difficult-to-attain LDL-C goal.
B90650 - ..
B90651 - The importance of aggressive LDL-C lowering in
B90652 - high-risk patients has been supported by the results of
B90653 - the Heart Protection Study,19 which showed that
B90654 - high-risk individuals with LDL-C lower than the drug
B90655 - initiation threshold also benefited from statin
B90656 - therapy, suggesting that the optimal LDL-C for
B90657 - high-risk patients may be below the goals recommended
B90658 - by the guidelines.
B90660 - ..
B90661 - The significant reductions in hs-CRP observed when
B90662 - ezetimibe was added to atorvastatin suggest an added
B90663 - anti-inflammatory effect of the combination, possibly
B90664 - resulting from the overall complex effect of ezetimibe
B90665 - on the lipid profile. Similar reductions in hs-CRP
B90666 - were observed when ezetimibe was added to a variety of
B90667 - statins.13
B90669 - ..
B90670 - In clinical practice, ezetimibe coadministered with a
B90671 - statin may enable more patients to achieve recommended
B90672 - target LDL-C levels by offering greater LDL-C lowering
B90673 - with fewer dose titrations as well as a well-tolerated
B90674 - alternative for patients in whom maximal dose statin
B90675 - monotherapy is inadequate. Ezetimibe has also been
B90676 - shown to be efficacious when coadministered with
B90677 - simvastatin. In a similarly designed study,15 the
B90678 - combination of ezetimibe (10 mg/d) and simvastatin
B90679 - (pooled doses of 10, 20, 40, and 80 mg/d) provided
B90680 - significantly greater reductions in LDL-C (13.8%) and
B90681 - triglyceride (7.5%) and increases in HDL-C (2.4%) than
B90682 - simvastatin alone (P<0.01). Combining the different
B90683 - mechanisms of action of these agents (inhibition of
B90684 - cholesterol synthesis by the statin and inhibition of
B90685 - cholesterol absorption across the intestinal wall by
B90686 - ezetimibe) appears to provide substantial incremental
B90687 - reductions in LDL-C, with additional favorable changes
B90688 - in total cholesterol, triglycerides, apo B, and HDL-C.
Ezetimibe Zeita Side Effects Similar Atorvastatin
BQ0401 - ..
BQ0402 - Side Effects Atorvastatin 10 MG with Ezetimibe 10 MB
BQ0403 - Ezetimibe 10 MB Side Effects with Atorvastatin 10 MG
BQ0404 - Side Effects Ezetimibe 10 MB with Atorvastatin 10 MG
BQ0406 - Atorvastatin side effects are listed in the record on 130603 0930.
BQ0407 - ref SDS 35 PC6O
BQ0409 - Research indicates Ezetimibe has similar side effects, suggesting
BQ0410 - compounding effect...
BQ0412 - Drugs.Com
BQ0414 - ..
BQ0415 - Ezetimibe Side Effects
BQ0417 - http://www.drugs.com/sfx/ezetimibe-side-effects.html
BQ0419 - ..
BQ0420 - General Comprehensive Listing...
BQ0422 - 1. Abdominal fullness
BQ0423 - 2. Black tarry stools
BQ0424 - 3. Bleeding gums
BQ0425 - 4. Bloating
BQ0426 - 5. Blood in urine or stools
BQ0427 - 6. Chills
BQ0428 - 7. Constipation
BQ0429 - 8. Darkened urine
BQ0430 - 9. Fast heartbeat
BQ0431 - 10. Fever
BQ0432 - 11. Gaseous abdominal pain
BQ0433 - 12. General tiredness or weakness
BQ0434 - 13. Indigestion
BQ0435 - 14. Large, hive-like swelling on face, eyelids, lips,
BQ0436 - tongue, throat, hands, legs, feet, sex-organs
BQ0437 - 15. Loss of appetite
BQ0438 - 16. Light-colored stools
BQ0439 - 17. Muscle cramps or spasms
BQ0440 - 18. Muscular tenderness, wasting or weakness
BQ0441 - 19. Nausea
BQ0442 - 20. Pains in stomach, side or abdomen, possibly radiating to the back
BQ0443 - 21. Pinpoint red spots on skin
BQ0444 - 22. Recurrent fever
BQ0445 - 23. Severe nausea
BQ0446 - 24. Skin rash
BQ0447 - 25. Unusual bleeding or bruising
BQ0448 - 26. Upper right abdominal pain
BQ0449 - 27. Vomitting
BQ0450 - 28. Yellow eyes or skin
BQ0452 - ..
BQ0453 - More Common
BQ0455 - 1. Fever
BQ0456 - 2. Headache
BQ0457 - 3. Muscle pain
BQ0458 - 4. Runny nose
BQ0459 - 5. Sore throat
BQ0461 - ..
BQ0462 - Less Common
BQ0464 - 1. Back pain
BQ0465 - 2. Body aches or pain
BQ0466 - 3. Chest pain
BQ0467 - 4. Chills
BQ0468 - 5. Cold or flu-like symptoms
BQ0469 - 6. Congestion
BQ0470 - 7. Coughing
BQ0471 - 8. Diarrhea
BQ0472 - 9. Difficulty in moving
BQ0473 - 10. Dizziness
BQ0474 - 11. Dryness or soreness of throat
BQ0475 - 12. Hoarseness
BQ0476 - 13. Muscle pain or stiffness
BQ0477 - 14. Pain in joints
BQ0478 - 15. Pain or tenderness around eyes or cheekbones
BQ0479 - 16. Shortness of breath or troubled breathing
BQ0480 - 17. Stomach pain
BQ0481 - 18. Stuffy nose
BQ0482 - 19. Tender, swollen glands in neck
BQ0483 - 20. Tighness of chest or wheezing
BQ0484 - 21. Trouble swallowing
BQ0485 - 22. Unusual tiredness or weakness
BQ0486 - 23. Voice changes
BQ0488 - ..
BQ0489 - [On 140430 0900 letter to VA notifies some minor dizziness
BQ0490 - has begun while taking Atorvastatin 10mg with Ezetimibe
BQ0491 - 10mg. ref SDS 57 PU43
BQ0493 - ..
BQ0494 - Karen's letter continues...
BQ0496 - -Continue physical activity and low fat/low cholesterol diet.
BQ0498 - -RTC in 4 weeks
BQ0500 - [On 131216 0028 letter to Doctor Alba and medical team
BQ0501 - submits pending issues to discuss during meeting on 131219,
BQ0502 - ref SDS 47 8N50, and lists TG/HDL-C ratio and LDL-P issues.
BQ0503 - ref SDS 47 6T49
BQ0505 - ..
BQ0506 - Patient was discussed with Dr Bikle
BQ0508 - ..
BQ0509 - There is a Doctor Daniel Bikle, PhD
BQ0511 - http://profiles.ucsf.edu/daniel.bikle
Atorvastatin 10 MG 4-week Trial VA Treatment Plan Test Side Effects
CS04 - 1702
CS0501 - ..
CS0502 - VA Confirm Work Plan Atorvastan 4-week Trial then Add Ezetimibe
CS0505 - Received letter from Doctor Alba saying...
CS0507 - 1. Subject: RE: VA Excellent Care Post CABG x4
CS0508 - Date: Mon, 25 Nov 2013 23:21:49 +0000
CS0515 - ..
CS0516 - 2. I am, sorry about the confusion, I thought you had received my
CS0517 - email
CS0519 - ..
CS0520 - 3. Plan is to start Atorvstatin 10 mg po daily- since you have 40
CS0521 - mg pills- I already ordered the 10 mg pills, so they can be
CS0522 - mailed to you, unless you prefer to pick them up.
CS0524 - [...below on 131125 0005 at 2048 letter to Doctor Alba and
CS0525 - reports taking Atorvastatin 40 mg, because have not
CS0526 - received prescription for 10 mg dose, and leaving town for
CS0527 - a week. ref SDS 0 2F66
CS0529 - ..
CS0530 - 4. I did not place an order for repeat labs in 4 weeks, since that
CS0531 - is not enough time to see the full effect of the Atorvastatin.
CS0533 - ..
CS0534 - 5. I wanted to follow up with you in 4 weeks to see if you are
CS0535 - tolerating the medication well, and to further discuss
CS0536 - treatment plan. Happy Holidays .
CS0538 - [On 131210 received letter from Doctor Alba asking about
CS0539 - progress taking Atorvastatin 40 mg, and requesting
CS0540 - submission of pending issues for next meeting. ref SDS 46
CS0541 - HY6O
CS0543 - ..
CS0544 - [On 131216 0028 letter to Doctor Alba and medical team
CS0545 - submits pending issues to discuss during meeting on 131219,
CS0546 - ref SDS 47 8N50, and lists TG/HDL-C ratio and LDL-P issues.
CS0547 - ref SDS 47 6T49
Chia Seeds Implement Recommend Manage Cholesterol Weight Energy Comm
DE04 - 2006
DE0501 - ..
DE0502 - Letter to Karen says...
DE0504 - 1. Subject: Chia Seeds - Mission Accomplished
DE0505 - Date: Mon, 25 Nov 2013 20:16:56 -0800
DE0512 - ..
DE0513 - 2. Thanks for your letter earlier today, shown above, ref SDS 0
DE0514 - 7Z3N, and facilitating communication with Doctor Alba through
DE0515 - her attending. Doctor Alba responded later in the afternoon,
DE0516 - so we are all on the same page.
DE0518 - ..
DE0519 - 3. Very grateful for your help investigating clinical trials that
DE0520 - avoid arteriosclerosis without using statins. [...cited in
DE0521 - Karen's letter earlier today, per above, ref SDS 0 V163, and
DE0522 - following up on patient's request in the letter to the VA
DE0523 - earlier this morning, per above. ref SDS 0 UK59 ...]. Trials
DE0524 - that might fit my patient profile were reviewed with Doctor
DE0525 - Egan during the meeting on 131017. ref SDS 40 179N
DE0527 - ..
DE0528 - 4. See in particular Alirocumab showing promising results, cited
DE0529 - in the record on line 600467.
DE0531 - ..
DE0532 - 5. Today, implemented your suggestion to try Chia seeds. The
DE0533 - check out lady at Costco, said, "Oh, Chia seeds! They're
DE0534 - great." That's the first time the check out lady has ever
DE0535 - commented on my groceries. Anyway, put some in regular dish
DE0536 - this evening, shown in case study on 120101 line 099395.
DE0537 - ref SDS 15 746M
DE0539 - ..
DE0540 - Karen suggested trying Chia seeds, during the meeting at the VA on
DE0541 - 131121 0930. ref SDS 44 NQ37
DE0543 - ..
DE0544 - Research on Chia seeds indicates it helps control cholesterol and
DE0545 - weight, and it increases energy. ref SDS 44 HK5J
DE0547 - ..
DE0548 - Letter to Karen continues...
DE0550 - 6. Didn't notice any change in taste, so Chia seeds seem benign.
DE0551 - Thanks for the tip.
Notify VA Implement Prescription Atorvastatin 10 MG 4-week Trial VA
EN04 - 2048
EN0501 - ..
EN0502 - Notify Doctor Alba Implement Prescription Atorvastatin Manage Cholesterol
EN0504 - Letter submitted to Doctor Alba saying...
EN0506 - 1. Subject: VA Meeting 21 Nov 2013, Clinical Trials Non-statin Solutions
EN0507 - Date: Mon, 25 Nov 2013 21:14:45 -0800
EN0514 - ..
EN0515 - 2. Thanks for your letter this afternoon, shown above, ref SDS 0
EN0516 - I67O, confirming understandings meeting at the VA this past
EN0517 - Thursday on 131121.
EN0519 - ..
EN0520 - 3. I'm leaving tonight for a week. Have not yet received your new
EN0521 - prescription Atorvastatin 10 MG. As you noticed in patient
EN0522 - history, Atorvastatin 40 MG was started on 131121. [...shown in
EN0523 - case study on 120101 0900. ref SDS 15 RN3F...].
EN0525 - ..
EN0526 - 4. 40 mg pills are on hand from Doctor Egan's prescription in
EN0527 - June, which was not implemented to avoid statin side effects.
EN0529 - ..
EN0530 - 5. Research further indicates good results adding Zetia to
EN0531 - Atvorstatin 10 mg. [...shown in the record today, above.
EN0532 - ref SDS 0 WL7I...]. While my goal is to avoid statins, it's
EN0533 - great that the VA and UCSF may have this solution available to
EN0534 - try in 4 weeks.
EN0536 - ..
EN0537 - 6. Some background on clinical trials to lower cholesterol without
EN0538 - statin drugs is shown in the record last month on 131017.
EN0539 - ref SDS 40 179N
EN0541 - ..
EN0542 - 7. See in particular Alirocumab showing promising results for a
EN0543 - non-statin, cited in the record on line 600467.
EN0545 - ..
EN0546 - 8. Very grateful for your support. Looking forward to meeting in
EN0547 - 4 weeks.
EN0549 - [On 131210 received letter from Doctor Alba asking about
EN0550 - progress taking Atorvastatin 40 mg, and requesting
EN0551 - submission of pending issues for next meeting. ref SDS 46
EN0552 - HY6O
EN0554 - ..
EN0555 - [On 131216 0028 letter to Doctor Alba and medical team
EN0556 - submits pending issues to discuss during meeting on 131219,
EN0557 - ref SDS 47 8N50, and lists TG/HDL-C ratio and LDL-P issues.
EN0558 - ref SDS 47 6T49
LDL < 70 Not Effective Goal Avoid Arterialsclorosis CVD CAD Manage C E6
FG0401 - ..
FG0402 - Research Arterialsclorsis Cornorary Artery Disease and Cholesterol
FG0403 - High LDL-C Low LDL-P Discordance Lowers Risk Shown by TG HDL-C Ratio 2
FG0405 - Follow up ref SDS 2 P95F.
FG0407 - Cholesterol was reviewed previously caring for Millie, reported on
FG0408 - 081226 0930. ref SDS 2 HK8O
FG0410 - ..
FG0411 - Found writing on the Internet....
FG0413 - 1. Tim Russert's Fatal Heart Attack Was Preventable, He Followed
FG0414 - Antiquated Advice
FG0416 - ..
FG0417 - Date............................. no date
FG0419 - http://livinlavidalowcarb.com/blog/tim-russerts-fatal-heart-attack-was-preventable-he-followed-antiquated-advice/2403
FG0421 - 1. In this supercharged and oftentimes volatile political
FG0422 - election year, something tragic and sudden struck this country
FG0423 - and has everyone buzzing in Washington and across the United
FG0424 - States. No, it wasn't some sex scandal, drug bust, or any of
FG0425 - the other usual news that has become almost too commonplace
FG0426 - these days. This was something much more serious and has
FG0427 - greater implications than even the extensive coverage the
FG0428 - mainstream media is giving to it.
FG0430 - ..
FG0431 - 2. Last Friday afternoon, hard-hitting political interviewer
FG0432 - and long-time host of NBC-TV's Sunday morning news talk
FG0433 - show "Meet the Press", Tim Russert, experienced his first
FG0434 - heart attack and it almost instantly killed him. I cannot
FG0435 - imagine how his family is responding to this news and my
FG0436 - sympathies and prayers go out to them during this very
FG0437 - difficult time. Tim was in the midst of doing what he
FG0438 - loved - preparing for his television show - when the heart
FG0439 - attack took his life and took him away from all of us.
FG0441 - ..
FG0442 - 3. So, how did a 58-year old man die from a heart attack when
FG0443 - he was doing all of the things his doctor said he should to
FG0444 - prevent it? Should we be concerned about what doctors are
FG0445 - telling us about how to ward off cardiovascular disease so
FG0446 - that we don?t become the next victim of what befell Tim
FG0447 - Russert? These are the questions people are asking in the
FG0448 - wake of this tragedy and was the subject of what one of my
FG0449 - readers wanted to know in an e-mail I received.
FG0451 - ..
FG0452 - 4. Here's what she wrote:
FG0454 - Hi Jimmy, I have been an avid reader of your blog for a
FG0455 - long time. I am so scared since Tim Russert died
FG0456 - suddenly of a heart attack at only age 58 (my husband
FG0457 - is 57 and I?m 54) that I'd really like to get some
FG0458 - clarification on the statin drugs and cholesterol
FG0459 - issue. Seems like Tim Russert's doctors did all the
FG0460 - usual things and he died anyway. I trust what Dr Jonny
FG0461 - Bowden has to say as he has an advanced degree in
FG0462 - nutrition and he seems to think for himself instead of
FG0463 - just following the status quo. Can you see if he would
FG0464 - help reassure me with this? Thanks for your
FG0465 - assistance, and keep up the fantastic work!
FG0467 - ..
FG0468 - 5. While I am no Dr Jonny Bowden, I do have some things to say
FG0469 - about Tim Russert's death that need to be said. I can
FG0470 - understand your concerns and I am delighted to forward your
FG0471 - questions to Dr Jonny Bowden. He's one of the brightest,
FG0472 - most articulate people on nutrition in the entire world, so
FG0473 - you are in good hands with the information he provides to
FG0474 - you.
FG0476 - ..
FG0477 - 6. But if you would allow me to comment on this subject, I
FG0478 - have some thoughts about it. Isn't it interesting that Tim
FG0479 - Russert did everything exactly as his doctor wanted him to
FG0480 - and yet his very first heart attack was a fatal one? I
FG0481 - don?t think that?s a coincidence either and it happens
FG0482 - every single day without a blink of an eye from anyone.
FG0484 - ..
FG0485 - 7. Watch this video interview with Russert's doctor to see how
FG0486 - dejected he is about Russert's "unexpected" death despite his
FG0487 - best treatment strategies. It's amazing to hear his doctor
FG0488 - basically say that Tim did everything he was "supposed" to do
FG0489 - and yet it wasn't enough to save his life. Wanna know what the
FG0490 - scariest part of this story is?
FG0493 - ..
FG0494 - Exercise Russert Overweight Died Low HDL High TG Despite LDL < 70
FG0495 - Russert Died Low HDL and High TG Several Years Excess Weight
FG0496 - Triglycerides High HDL Low Russert Died CVD with Low LDL Excess Weight
FG0497 - HDL Low Triglycerides High Russert Died CVD with Low LDL Excess Weight
FG0500 - 8. Check out Tim Russert's lipid profile:
FG0502 - LDL-68
FG0503 - HDL-37 (up from the lower 20's)
FG0504 - Total Cholesterol-105
FG0506 - ..
FG0507 - 9. Did you see that? Most doctors would look at those numbers
FG0508 - and say, "See how healthy this person is because we lowered
FG0509 - his cholesterol." And they would pound their chest with
FG0510 - pride at putting someone like Tim Russert on a statin drug
FG0511 - to artificially make this happen. But what good did it do
FG0512 - him in the end? He's gone now because of that advice and
FG0513 - there's no outrage about it. Worry, concern, perplexity,
FG0514 - yes - but nobody is angry that this preventable death was
FG0515 - made WORSE by the use of all the traditional means for
FG0516 - improving heart health.
FG0518 - ..
FG0519 - 10. According to Russert's doctor, he didn't have Type 2 diabetes
FG0520 - nor did he have any blood sugar issues at all. His A1c was in
FG0521 - the normal range and as I noted previously his cholesterol was
FG0522 - considered VERY healthy. For all intents and purposes according
FG0523 - to the modern day medical conventional wisdom, he was the
FG0524 - epitome of perfect health. And yet he tragically died before
FG0525 - his time.
FG0527 - ..
FG0528 - 11. We now know posthumously that Russert had coronary heart
FG0529 - disease that he was being treated for, but his doctor
FG0530 - apparently didn't know how severe it was. But even if he
FG0531 - did know it was extremely serious, what else would he have
FG0532 - recommended to Tim? Higher doses of his statin drug? Even
FG0533 - less fat in his diet? More exercise? In the end, all of
FG0534 - these seemingly good strategies from the conventional
FG0535 - wisdom point of view would have very likely done NOTHING to
FG0536 - prevent this from happening.
FG0538 - ..
FG0539 - Exercise Bike Failed Russert Overweight
FG0542 - 12. His doctor put him on blood pressure lowering medication as
FG0543 - well as a cholesterol-lowering statin drug to see if that
FG0544 - would help. And Russert even rode an exercise bike to try
FG0545 - to lose weight, although it didn't work. There's no doubt
FG0546 - the plaque buildup around his heart was getting bigger and
FG0547 - bigger over the years until his heart couldn't take it any
FG0548 - longer.
FG0550 - ..
FG0551 - This record indicates that merely "exercising" is not sufficient for
FG0552 - cardiovasular health, unless eating food is reduced and exercise is
FG0553 - balanced sufficiently to avoid being overweight.
FG0555 - ..
FG0556 - The problem is more urgent for insulin resistant people with
FG0557 - diabetes.
FG0560 - ..
FG0561 - Article Tim Russert's Fatal Heart Attack Preventable continued...
FG0563 - 13. We know that too low LDL can lead to depression, suicide
FG0564 - and death. We also know that HDL "good" cholesterol
FG0565 - (Russert's was very low-NOT good) and triglycerides
FG0566 - (something Russert dealt with having too high over the past
FG0567 - few years) are better indicators of heart health than LDL
FG0568 - and total cholesterol. And it's a high-carb, low-fat diet
FG0569 - that leads to lower HDL and higher triglycerides. No doubt
FG0570 - this is precisely the kind of diet Russert?s doctor had him
FG0571 - on.
Cholesterol Research Internet Low Carbohydrate Diet Lower Triglyceri
GL0401 - ..
GL0402 - Low-Carb Diet Lower Triglycerides Large LDL Particle Size Protective
GL0403 - LDL 246 Cholesterol 326 Healthy with TG 77 HDL 65
GL0404 - LDL-P Size Large Fluffy Protective with HDL 65 and TG 77
GL0405 - Protective LDL Particle Large Size Fluffy with HDL 65 and TG 77
GL0407 - Author reports personal lipid profile similar to lab on 131015 0724.
GL0408 - ref SDS 38 IM9N
GL0410 - 14. As you know from reading my blog, my most recent total
GL0411 - cholesterol reading was 326 with an LDL of 246, HDL of 65,
GL0412 - and triglycerides at 77. I am confident I don't need to go
GL0413 - on a statin drug now or ever and I am as healthy as I have
GL0414 - ever been in my entire life. On face value, any typical
GL0415 - physician in America would say to me, "Oh my God, you need
GL0416 - to be on Lipitor, Crestor, or Zetia to lower your LDL and
GL0417 - total cholesterol."
GL0419 - ..
GL0420 - 15. Of course, they would be 100% wrong because my LDL particle
GL0421 - size is the protective large, fluffy kind that your body
GL0422 - wants and needs. Dr Eric Westman from Duke University
GL0423 - Medical Center in Durham, North Carolina, who is the
GL0424 - physician who ran this test on my behalf, said almost all
GL0425 - of my LDL is this protective kind and the percentage of
GL0426 - small, dense LDL (which was the likely culprit in Russert's
GL0427 - fatal heart attack) is virtually nil. And that's a GREAT
GL0428 - thing! High LDL can be good, but low HDL is most certainly
GL0429 - ALWAYS a bad thing to have.
GL0431 - [...below on 131125 0005 this article Doctor Sigurdsson
GL0432 - explains discordant lab results for LDL-C high and
GL0433 - LDL-particle low is healthy profile, because LDL
GL0434 - particles are large with high concentration of
GL0435 - cholesterol that cannot penetrate the endothelial layer
GL0436 - lining artery walls, and so prevents arterialsclorosis.
GL0437 - ref SDS 0 M95O
GL0439 - ..
GL0440 - [...below on 131125 0005 this article Doctor Sigurdsson
GL0441 - further reports patients with small-dense LDL particles
GL0442 - have 3-fold increase risk of CVD than patients with
GL0443 - large-fluffy LDL particles, which is protective against
GL0444 - CVD. ref SDS 0 N044
GL0446 - ..
GL0447 - [...below on 131125 0005 this article Doctor Attia
GL0448 - explains discordant lab results for LDL-C high and
GL0449 - LDL-particle low is healthy profile, because LDL
GL0450 - particles are large with high concentration of
GL0451 - cholesterol that cannot penetrate the endothelial layer
GL0452 - lining artery walls, and so prevents arterialsclorosis.
GL0453 - ref SDS 0 FM6L
GL0455 - ..
GL0456 - [...below on 131125 0005 another article presents
GL0457 - diagrams of small LDL particles with high concentration
GL0458 - of triglycerides and depleted cholesterol, and comparing
GL0459 - with large LDL particles with low concentrations of
GL0460 - triglycerides and high concentration of cholesterol,
GL0461 - sometimes described as "fluffy" LDL particles.
GL0462 - ref SDS 0 1V4J
GL0466 - ..
GL0467 - Low Carb Diet TG/HDL Ratio < 2 Lower Risk Arterialsclorosis CVD
GL0468 - TG/HDL Ratio < 2 Low Carb Diet Lower Risk Arterialsclorosis CVD
GL0469 - Ratio TG/HDL < 2 Low Carb Diet Lower Risk Arterialsclorosis CVD
GL0472 - 16. When you are livin' la vida low-carb correctly, then your HDL
GL0473 - will be well above 50 and for women well above 70. At the same
GL0474 - time, your triglycerides will drop below 100 for an
GL0475 - HDL/triglyceride ratio of around 1. That's what you want. Of
GL0476 - course, you will need to get the particle size of your
GL0477 - cholesterol subsets measured using a VAP or Berkeley test, but
GL0478 - you can almost be guaranteed that if your HDL is up over 50 and
GL0479 - your triglycerides are down below 100 that your LDL particle
GL0480 - size will be the large, fluffy protective kind.
GL0482 - [...below on 131125 0005 article "Doc's Opinion" by
GL0483 - Doctor Axel F Sigurdsson recommends low-carb diet for
GL0484 - lowering LDL-P. ref SDS 0 QP9F and ref SDS 0 J56H
GL0486 - ..
GL0487 - [...below on 131125 0005 article "Doc's Opinion" by
GL0488 - Doctor Axel F Sigurdsson cites TG/HDL ratio > 2 signals
GL0489 - high risk arterialsclorosis and CVD. ref SDS 0 666G
GL0491 - ..
GL0492 - [...below on 131125 0005 review of article by Doctor
GL0493 - Attia, seems to support reliance on TG/HDL-C ratio to
GL0494 - approximate results of LDL-P testing. ref SDS 0 338N
GL0496 - ..
GL0497 - [...below on 131125 0005 abstract article published by
GL0498 - Pub Med.gov combined parameter, the TG/HDL-C ratio, is
GL0499 - beneficial for assessing the presence of small LDL.
GL0500 - ref SDS 0 VR5N
GL0502 - ..
GL0503 - [On 131216 0028 letter to Doctor Alba and medical team
GL0504 - submits pending issues to discuss during meeting on
GL0505 - 131219, ref SDS 47 8N50, and lists TG/HDL-C ratio and
GL0506 - LDL-P test issues. ref SDS 47 6T49
GL0508 - ..
GL0509 - [On 140201 1159 obtained blood draw for Lipid NMR test
GL0510 - LDL-P at Labcor on Health Testing Centers order #
GL0511 - 27716. ref SDS 53 KQ4L
Doc's Opinion Axel F Sigurdsson Research Internet Arterialsclorosis
HD0401 - ..
HD0402 - Cholesterol Bound Atherogenic Lipoproteins Causes Aterialsclorosis
HD0405 - Another article says...
HD0407 - 2. Doc's Opinion
HD0409 - Doc's opinion is written and edited by Axel F Sigurdsson
HD0410 - MD, PhD, FACC. Dr Sigurdsson is a cardiologist at the
HD0411 - Department of Cardiology at the Landspitali University
HD0412 - Hospital in Reykjavik Iceland. He also practices
HD0413 - cardiology at Hjartamidstodin (The Heart Center) which is a
HD0414 - private heart clinic in the Reykjavik area. He is a Fellow
HD0415 - of the American College of Cardiology (ACC), The Icelandic
HD0416 - Society of Cardiology and the Swedish Society of
HD0417 - Cardiology.
HD0419 - ..
HD0420 - Date............................. 21 November 2012
HD0422 - http://www.docsopinion.com/2012/11/21/the-difference-between-ldl-c-and-ldl-p/
HD0424 - ..
HD0425 - 1. The lipid hypothesis, suggesting a causative role for
HD0426 - cholesterol in atherosclerotic heart disease is by many
HD0427 - considered one of the best proven hypotheses in modern
HD0428 - medicine. Measurements of total cholesterol, and the magnitude
HD0429 - of cholesterol bound to different lipoproteins, are commonly
HD0430 - used to assess the risk of future cardiovascular events.
HD0431 - However, recent research into the role of lipoproteins in
HD0432 - atherosclerosis, the role of oxidation and inflammation, has
HD0433 - indicated that cholesterol in itself does not cause
HD0434 - atherosclerosis. It is only when cholesterol bound to
HD0435 - atherogenic lipoproteins becomes trapped within the arterial
HD0436 - wall, that it becomes a part of the atherosclerotic process.
HD0437 - Certainly, atherosclerosis as we know it will not occur in the
HD0438 - absence of cholesterol. Thus, cholesterol is definitively
HD0439 - involved, and necessary for atherosclerosis to occur, but so
HD0440 - are many other important organic molecules that play a role in
HD0441 - health and disease. The necessity of cholesterol does not
HD0442 - prove its causative role. So, in order to understand the
HD0443 - pathophysiology of atherosclerosis and the role of lipoproteins
HD0444 - and inflammation, we may have to loosen our grip on
HD0445 - cholesterol, at least for the time being.
HD0447 - ..
HD0448 - 2. Lipoproteins and atherosclerosis
HD0450 - The insolubility of lipids in water poses a problem because
HD0451 - lipids must be transported through aqueous compartments
HD0452 - within the cell as well as in the blood and tissue spaces.
HD0453 - Lipoproteins are biochemical structures that enable
HD0454 - transport of lipids throughout the body. A lipoprotein
HD0455 - includes a core, consisting of a droplet of triglycerides
HD0456 - and/or cholesterlyl esters, a surface layer of
HD0457 - phospholipid, unesterified cholesterol and specific
HD0458 - proteins (apolipoproteins). Lipoprotein particles are
HD0459 - commonly classified according to their density, thus the
HD0460 - terms high density lipoprotein (HDL) and low density
HD0461 - lipoprotein (LDL). Apolipoprotein B (apoB) is the primary
HD0462 - lipoprotein in LDL. ApoB containing lipoproteins play a
HD0463 - hugely important role in atherosclerosis. In
HD0464 - atherosclerosis aplipoprotein containing lipoproteins
HD0465 - become trapped within the arterial wall, even when blood
HD0466 - levels of cholesterol are normal.
HD0468 - ..
HD0469 - 3. Atherosclerosis is a complex process. Initially, LDL and other
HD0470 - apoB containing lipoproteins enter the arterial wall. Why this
HD0471 - happens and why lipoproteins are retained in the wall of the
HD0472 - artery is still not completely clear. Chemical substances
HD0473 - called proteoglycans play an important role for the retention
HD0474 - of apoB containing lipoproteins within the arterial wall. This
HD0475 - chemical intrusion then appears to initiate a maladaptive and
HD0476 - chronic inflammatory response leading to the formation of an
HD0477 - atherosclerotic plaque. Such plaques may cause narrowing of
HD0478 - important vessels such as the coronary arteries. A rupture of
HD0479 - such a plaque with subsequent thrombosis may lead to an acute
HD0480 - occlusion of a coronary artery causing an acute myocardial
HD0481 - infarction.
HD0483 - ..
HD0484 - 4. The difference between LDL-C and LDL-P
HD0486 - In the clinical world, an important question is how we can
HD0487 - use laboratory measurements to assess individual risk.
HD0488 - Calculated, or less frequently measured low density
HD0489 - lipoprotein cholesterol (LDL-C ) is the most commonly used
HD0490 - marker to assess risk. LDL-C is also used to target
HD0491 - therapy in primary as well as secondary prevention of
HD0492 - cardiovascular disease. This is partly due to the fact
HD0493 - that most of the cholesterol in the blood is carried in
HD0494 - LDL's. Moreover, there appears to be a strong and graded
HD0495 - association between LDL-C and the risk for cardiovascular
HD0496 - disease. However, LDL-levels may not be correctly assessed
HD0497 - by the measurements of cholesterol carried within these
HD0498 - particles.
Doc's Opinion Axel F Sigurdsson Research Internet Arterialsclorosis
I60401 - ..
I60402 - Triglycerides Indicate Small LDL Particle Size High Risk CVD
I60403 - High LDL Particle Count Indicates Cholesterol Depleted LDL
I60404 - Artiarialsclorosis Caused by High Number LDL Particles LDL-P
I60405 - Cholesterol in LDL Particles Not Causative Artialsclorosis
I60408 - 5. Let me explain this a little bit further. LDL-C is a
I60409 - measurement of the cholesterol mass within LDL-particles.
I60410 - Due to the fact that LDL-C has been traditionally used for
I60411 - so many years to reflect the amount of LDL, LDL-C and LDL
I60412 - have become almost synonymous. This may be quite
I60413 - misleading, because the cholesterol content of LDL
I60414 - particles varies greatly. Thus, LDL-C is a surrogate
I60415 - measure that only provides an estimate of LDL levels.
I60416 - Studies indicate that the risk for atherosclerosis is more
I60417 - related to the number of LDL particles (LDL-P) than the
I60418 - total amount of cholesterol within these particles.
I60420 - ..
I60421 - 6. It is also important to remember that LDL particles carry
I60422 - other molecules than cholesterol. For example,
I60423 - triglycerides (TG) are also carried within LDL-particles.
I60424 - Similar to total cholesterol and LDL-C, there is an
I60425 - association between serum TG and the risk of cardiovascular
I60426 - disease. TG molecules are larger than cholesterol ester
I60427 - molecules. If the number of TG molecules in an
I60428 - LDL-particle is high, there will be less space for
I60429 - cholesterol molecules. Therefore, if triglycerides are
I60430 - high, it may take many more LDL particles to carry a given
I60431 - amount of cholesterol. Therefore high LDL particle count
I60432 - may be associated with small, cholesterol depleted,
I60433 - triglyceride rich particles. Research has shown that high
I60434 - levels of triglycerides are associated with small LDL
I60435 - particle size.
I60437 - [...below on 131125 0005 article by Doctor Attia
I60438 - maintains arterialsclerosis plaque caused by cholesterol
I60439 - depleted and triglyceride rich LDL particles that are
I60440 - small and dense enough to penetrate endothelial layer
I60441 - lining arterial wall. ref SDS 0 JT6K
I60443 - ..
I60444 - [...below on 131125 0005 report on study in 2007,
I60445 - maintains arterialsclerosis plaque caused by cholesterol
I60446 - rich LDL particles within the arterial wall. ref SDS 0
I60447 - UU8M
I60449 - ..
I60450 - 7. Now, what does all this mean? It means that one person
I60451 - (person A) may have large cholesterol rich LDL particles,
I60452 - while another (person B) may have smaller cholesterol
I60453 - depleted particles. These two persons may have the same
I60454 - LDL-C concentration. However, person B will have higher
I60455 - LDL particle number (LDL-P). Despite similar levels of
I60456 - LDL-C, person B is at higher risk for future cardiovascular
I60457 - events. Furthermore, person B will have more small
I60458 - LDL-particles.
I60460 - [...below on 131125 0005 this article Doctor Attia
I60461 - further explains discordant lab results for LDL-C high
I60462 - and LDL-particle low is healthy profile, because LDL
I60463 - particles are large with high concentration of
I60464 - cholesterol that cannot penetrate the endothelial layer
I60465 - lining artery walls, and so prevents arterialsclorosis.
I60466 - ref SDS 0 FM6L
I60468 - ..
I60469 - [...below on 131125 0005 another article presents
I60470 - diagrams of small LDL particles with high concentration
I60471 - of triglycerides and depleted cholesterol, and comparing
I60472 - with large LDL particles with low concentrations of
I60473 - triglycerides and high concentration of cholesterol,
I60474 - sometimes described as "fluffy" LDL particles.
I60475 - ref SDS 0 1V4J
I60478 - ..
I60479 - LDL-C Low May Indicate High Risk CVD Arterialsclorsis Discordance
I60480 - Discordance Low LDL-C May Indicate High Risk CVD Arterialsclorsis
I60481 - ApoB LDL-P Both Predict Risk CVD Arterialsclorsis Better than LDL-C
I60482 - LDL-P Size Small 300% Greater Risk CVD Large LDL-P Cholesterol Protective
I60485 - Large Fluffy LDL Particles Protective 300% Lower Risk than Small Dense LDL
I60487 - 8. Some studies have suggested that the size of LDL-particles
I60488 - may be of importance. People whose LDL particles are
I60489 - predominantly small and dense, have a threefold greater
I60490 - risk of coronary heart disease. Furthermore, the large and
I60491 - fluffy type of LDL may actually be protective. However, it
I60492 - is possible that the association between small LDL and
I60493 - heart disease reflects an increased number of LDL particles
I60494 - in patients with small LDL. Therefore, the LDL particle
I60495 - count could be more important in terms of risk than
I60496 - particle size in itself.
I60498 - ..
I60499 - [...above on 131125 0005 line - Doctor Attia's
I60500 - explanation here of cholesterol-depleted and
I60501 - triglyceride-rich LDL particles indicates large number
I60502 - of "small-size" LDL particles that present much higher
I60503 - risk of penetrating endothelial layer lining arteries to
I60504 - cause arterialsclorosis and CVD, and that LDL particles
I60505 - that are "large-fluffy" cholesterol-rich and
I60506 - triglyceride depleted lower risk of CVD - aligns with
I60507 - explanation above. ref SDS 0 6P4N
I60509 - ..
I60510 - [On 140201 1159 obtained blood draw for Lipid NMR test
I60511 - LDL-P at Labcor on Health Testing Centers order # 27716.
I60512 - ref SDS 53 KQ4L
I60514 - ..
I60515 - 9. ApoB and LDL-P both reflect the number of atherogenic
I60516 - lipoprotein particles. Measurements of ApoB and LDL-P are
I60517 - better predictors of cardiovascular disease risk than LDL-C.
I60518 - Furthermore, ApoB and LDL-P may predict residual risk among
I60519 - individuals who have had their LDL-C levels lowered by statin
I60520 - therapy.
I60522 - ..
I60523 - 10. Discordance
I60525 - Discordance is when there is a difference between LDL-C and
I60526 - LDL-P. If LDL-C is high and LDL-P is low, there is
I60527 - discordance. If LDL-C is low and LDL-P is high, there is
I60528 - discordance. If both are low or both high, there is no
I60529 - discordance. Studies have indicated that if there is
I60530 - discordance between LDL-C and LDL-P, cardiovascular disease
I60531 - risk tracks more closely with LDL-P than LDL-C.
I60532 - Specifically, when a patient with low LDL-C has a level of
I60533 - LDL-P that is not equally low, there is higher "residual"
I60534 - risk. This may help explain the high number of
I60535 - cardiovascular events that occur in patients with normal or
I60536 - low levels of LDL-C.
I60538 - ..
I60539 - 11. An analysis of "Get With the Guidelines" data published in
I60540 - 2009 studied almost 137 thousand patients with an acute
I60541 - coronary event. Almost half of those had admission LDL
I60542 - levels <100 mg/dL (2.6 mmol/L). Thus, LDL-C does not seem
I60543 - to be predicting risk in these patients. However, low
I60544 - HDL-C and elevated TG was common among these patients. Low
I60545 - HDL-C and high TG is generally associated with higher
I60546 - LDL-P.
Doc's Opinion Axel F Sigurdsson Research Internet Metabolic Syndrome
J00401 - ..
J00402 - Lipid Panal ApoB LDL-P Assess CVD Risk Better than LDL-C Misleading
J00403 - CVD Risk High LDL-P High and LDL-C Low Metabolic Syndrome Means Overweight
J00404 - LDL-P High and LDL-C Low High Risk CVD Metabolic Syndrome Means Overweight
J00405 - Metabolic Syndrome Means Overweight LDL-P High and LDL-C Low High Risk CVD
J00408 - 12. Among discordant patients in the Framingham Offspring Study
J00409 - the group with the highest risk for future cardiovascular
J00410 - events had high LDL-P and low LDL-C, while the group with
J00411 - the lowest risk had low LDL-P but higher LDL-C. Many
J00412 - patients with the metabolic syndrome or type-2 diabetes
J00413 - have the type of discordance where LDL-P is elevated but
J00414 - LDL-C may be close to normal. In these individuals,
J00415 - measurements of LDL-C may underestimate cardiovascular
J00416 - risk. Measurements of ApoB or LDL-P may therefore be
J00417 - helpful in these individuals.
J00419 - [On 150526 1300 Doctor Stewart at VA MCSF recommended
J00420 - book "Fat Chance" for managing metabolic syndrome toward
J00421 - better health; book was criticized for lack of
J00422 - scientific founding, and presenting unrealistic
J00423 - remedies. ref SDS 68 ZA9O
J00425 - ..
J00426 - 13. Discordance may be an important clinical phenomenon.
J00427 - Sometimes the question of medical therapy in primary
J00428 - prevention arises when there is intermediate risk, based on
J00429 - LDL-C. In these cases a low LDL-P level might help to
J00430 - confirm that the risk is indeed low, which might justify
J00431 - avoiding statin therapy.
Doc's Opinion Axel F Sigurdsson Research Internet Arterialsclorosis
K10401 - ..
K10402 - LDL-C Lower Statins Misleading Don't Lower LDL-P ApoB
K10403 - Statin Medication Lowers LDL-C More than LDL-P Misleading
K10406 - 14. Statins tend to lower LDL-C more than LDL-P. Many
K10407 - individuals who reach the target for LDL-C with statins,
K10408 - may still have raised LDL-P. This may indicate residual
K10409 - risk despite what is generally defined as adequate
K10410 - treatment.
K10412 - ..
K10413 - 15. Effect of therapies
K10415 - In general, most methods that lower LDL-C have some ability
K10416 - to lower LDL-P. However, there are some differences. Much
K10417 - has been written about how to lower LDL-C. Most doctors
K10418 - will recommend eating less fat and cholesterol from meat
K10419 - and dairy products. Statin therapy significantly lowers
K10420 - LDL-C. Therapies may affect LDL-P differently.
K10421 - Interventions that will lower LDL-C more than LDL-P include
K10422 - statins, estrogen replacement therapy, some
K10423 - antiretrovirals, and a low-fat, high-carbohydrate diet.
K10425 - ..
K10426 - This analysis reflects explanation of discordance, above. ref SDS 0
K10427 - E36J
Eating Academy Peter Attia MD Research Internet Arterialsclorosis Ch
LB0401 - ..
LB0402 - Niacin Low-Carbohydrate Diet Reduces Triglycerides Lowers LDL-P
LB0403 - Triglycerides Lower Exercise Weight Loss Fibrates Niacin
LB0404 - LDL-P Lowered by Exercise Low-Carbohydrate Diet Reduces Triglycerides
LB0405 - Carbohydrate Restriction Lowers LDL-P by Lowering Triglycerides
LB0408 - Exercise Lowers LDL-P
LB0410 - 16. Interventions that lower LDL-P more than LDL-C include
LB0411 - fibrates, niacin, pioglitazone, omega-3 fatty acids,
LB0412 - exercise and Mediterranean and low carbohydrate diets.
LB0413 - Although statins lower LDL-P, they may leave a significant
LB0414 - number of patients above the LDL-P target.
LB0416 - [...above on 131125 0005 patient Internet report that
LB0417 - low-carb diet supports raising HDL, lowering
LB0418 - triglycerides and lowering LDL-P. ref SDS 0 5P5N
LB0420 - ..
LB0421 - [...below on 131125 0005 other authorities recommend
LB0422 - lowering triglycerides < 140 signals low LDL-P < 1000
LB0423 - and that LDL particles are large filled with cholesterol
LB0424 - (causing LDL-C to rise), rather than small, dense filled
LB0425 - with triglycerides, which cause arterialsclorisis; this
LB0426 - can be accomplished using interventions - weight loss,
LB0427 - exercise, fibrates niacin. ref SDS 0 PD69
LB0429 - ..
LB0430 - [...below on 131125 0005 another authority advises that
LB0431 - exercise lowers triglycerides. ref SDS 0 T68I
LB0434 - ..
LB0435 - LDL-C Limited Value Misleading Risk Assessment Arterialsclorosis
LB0436 - Metabolic Syndrome TG High HDL Low LDL-P ApoB High LDL-C Low Misleading
LB0437 - LDL-C Low Misleading Metabolic Syndrome TG High HDL Low LDL-P ApoB High
LB0440 - 17. Patients with high levels of triglycerides and low HDL-C
LB0441 - are likely to have high LDL-P despite normal or low LDL-C.
LB0442 - Such a lipid profile is typical for individuals with the
LB0443 - metabolic syndrome. Studies indicate that these patients
LB0444 - may benefit most from low carbohydrate diets and that
LB0445 - carbohydrate restriction reduces LDL-P.
LB0447 - [...above on 131125 0005 patient Internet report that
LB0448 - low-carb diet supports raising HDL, lowering
LB0449 - triglycerides and lowering LDL-P. ref SDS 0 5P5N
LB0451 - ..
LB0452 - [On 150526 1300 Doctor Stewart at VA MCSF recommended
LB0453 - book "Fat Chance" for managing metabolic syndrome toward
LB0454 - better health; book was criticized for lack of
LB0455 - scientific founding, and presenting unrealistic
LB0456 - remedies. ref SDS 68 ZA9O
LB0458 - ..
LB0459 - 18. LDL-P is not generally used in Europe to assess cardiovascular
LB0460 - risk. So far, these measurements have primarily been performed
LB0461 - in the United States. Clinical guidelines in Europe still
LB0462 - recommend measurements of LDL-C to assess risk. Furthermore,
LB0463 - LDL-C is still recommended to assess the effect of statin
LB0464 - therapy. However, due to the fact that LDL-C is only a
LB0465 - surrogate marker of the availability of atherogenic
LB0466 - lipoproteins, its use may be of limited value. Measurements of
LB0467 - LDL-P and ApoB are better predictors of cardiovascular risk and
LB0468 - provide a better reflection of the atherogenic potential of
LB0469 - lipoproteins.
LB0471 - ..
LB0472 - 19. Questions and Answers on this article...
LB0474 - 1. Reijo Laatkainen
LB0475 - 22 November 2012
LB0477 - ..
LB0478 - Very nice post. Thanks clarifying this pretty
LB0479 - complicated subject. How convincing is the evidence in
LB0480 - your opinion that LDL-P should be the primary parameter
LB0481 - to follow? Does it add anything on top of ApoB?
LB0484 - ..
LB0485 - Lipid Panal ApoB LDL-P Assess CVD Risk Better than LDL-C Misleading
LB0486 - CVD Risk High LDL-P High and LDL-C Low Metabolic Syndrome Means Overweight
LB0487 - LDL-P High and LDL-C Low High Risk CVD Metabolic Syndrome Means Overweight
LB0488 - Metabolic Syndrome Means Overweight LDL-P High and LDL-C Low High Risk CVD
LB0491 - Doc's opinion November 22, 2012
LB0493 - ..
LB0494 - Thanks Reijo. The problem with the LDL-P measurements
LB0495 - using NMR spectroscopy is that it is still rather
LB0496 - expensive. It has been suggested that looking at
LB0497 - non-HDL cholesterol (total cholesterol minus HDL
LB0498 - cholesterol), HDL-C and triglycerides may be helpful
LB0499 - when LDL-P and ApoB are not available. This could be
LB0500 - important in patients with the metabolic syndrome,
LB0501 - where LDL-C may underestimate risk. Non-HDL
LB0502 - cholesterol reflects the cholesterol within all
LB0503 - lipoprotein particles currently considered
LB0504 - ateherogenic. Many studies have indicated that it is a
LB0505 - better predictor of cardiovascular events than is
LB0506 - LDL-C. However I still think LDL-P measurements may
LB0507 - often give important additive information and I my
LB0508 - guess is that it's use will become more common in the
LB0509 - near future. However, the clinical utility of these
LB0510 - measurements is still limited because the technique is
LB0511 - not widely available and it is relatively expensive.
LB0513 - ..
LB0514 - In clinical terms, LDL-P does not add much to ApoB.
LB0515 - LDL-P measures the number of LDL-particles while ApoB
LB0516 - measures the number of all atherogenic particles
LB0517 - (chylomicrons, VLDL,IDL,LDL and Lp(a)). Usually 85-90%
LB0518 - of ApoB represent LDL-particles. Therefore, in most
LB0519 - cases you don't need ApoB if you have LDL-P available
LB0520 - and vice versa.
LB0522 - ..
LB0523 - Restates prior recommendation to measure LDL-P and/or ApoB in lipid
LB0524 - panel tests, per above. ref SDS 0 C347
LB0526 - [On 140201 1159 obtained blood draw for Lipid NMR
LB0527 - test LDL-P at Labcor on Health Testing Centers
LB0528 - order # 27716. ref SDS 53 KQ4L
LB0530 - ..
LB0531 - Article Doc's Opinion by Axel F Sigurdsson continues...
LB0533 - 2. Richard May
LB0534 - 30 January 2013
LB0536 - ..
LB0537 - Hi doc, any thoughts on the usefulness of TG/HDL
LB0538 - ratios? I've heard that TG is a fairly accurate proxy
LB0539 - for ApoB count. Plus TG numbers are easy to obtain.
LB0540 - thx!
LB0542 - ..
LB0543 - Doc's opinion
LB0544 - January 31, 2013
Doc's Opinion Axel F Sigurdsson MD Research Internet Arterialscloros
MK0401 - ..
MK0402 - Metabolic Syndrome Overweght Obese TG/HDL Ratio > 3.5
MK0403 - Overweght Metabolic Syndrome TG/HDL Ratio > 3.5 Obese
MK0404 - Obese Metabolic Syndrome Overweght TG/HDL Ratio > 3.5
MK0405 - TG/HDL Ratio > 3.5 Apply When LDL-P ApoB Not Available Lipid Panel
MK0408 - @ Richard. Evidence suggests that there is an
MK0409 - association between TG/HDL-C ratio and cardiovascular
MK0410 - risk. This ratio has also been shown to be associated
MK0411 - with insulin resistance. Thus, the higher your TG and
MK0412 - the lower your HDL-C, the greater degree of insulin
MK0413 - resistance. Therefore it may be particularly helpful
MK0414 - in individuals with the metabolic syndrome where the
MK0415 - traditional LDL-C often underestimates risk. A
MK0416 - TG/HDL-C ratio above 3.5 has often been used as cutoff
MK0417 - for identifying insulin resistance. As you say, this
MK0418 - ratio is easy to obtain, it is included in the
MK0419 - traditional lipid panel, and therefore relatively
MK0420 - cheap.
MK0423 - ..
MK0424 - This point by Doctor Axel F Sigurdsson seems to align with prior
MK0425 - article indicating that TG/HDL-D < 2 ratio lowers risk of
MK0426 - arterialsclorsis and heart attack (CVD event), per above. ref SDS 0
MK0427 - 5P5N
MK0429 - [...below on 131125 0005 review of article by Doctor Attia,
MK0430 - seems to support reliance on TG/HDL-C ratio to approximate
MK0431 - results of LDL-P testing. ref SDS 0 338N
MK0433 - ..
MK0434 - [...below on 131125 0005 abstract article published by Pub
MK0435 - Med.gov combined parameter, the TG/HDL-C ratio, is
MK0436 - beneficial for assessing the presence of small LDL.
MK0437 - ref SDS 0 VR5N
MK0439 - ..
MK0440 - [On 131216 0028 letter to Doctor Alba and medical team
MK0441 - submits pending issues to discuss during meeting on
MK0442 - 131219, ref SDS 47 8N50, and lists TG/HDL-C ratio and
MK0443 - LDL-P issues. ref SDS 47 6T49
MK0445 - ..
MK0446 - [On 140201 1159 obtained blood draw for Lipid NMR test
MK0447 - LDL-P at Labcor on Health Testing Centers order # 27716.
MK0448 - ref SDS 53 KQ4L
MK0450 - ..
MK0451 - [On 150526 1300 Doctor Stewart at VA MCSF recommended book
MK0452 - "Fat Chance" for managing metabolic syndrome toward better
MK0453 - health; book was criticized for lack of scientific
MK0454 - founding, and presenting unrealistic remedies. ref SDS 68
MK0455 - ZA9O
MK0459 - ..
MK0460 - Diagram LDL Particle Count Higher Triglycerides Rich/Cholesterol Depleted
MK0463 - Doctor Sigurdsson cites another source on Internet with PDF
MK0464 - diagrams...
MK0466 - 3. Relationship of LDL-C & LDL-P