CONTACTS
SUBJECTS
VA Commend Great Care Recover CABG 4x Heart Surgery 091022 Prevent C
0803 -
0803 - ..
0804 - Summary/Objective
0805 -
080501 - Follow up ref SDS 44 0000. ref SDS 41 0000.
080502 -
080503 -
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
080541 -
080542 -
080543 -
080545 - ..
0806 -
0807 -
0808 - Background
0809 -
0810 -
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
081027 -
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
081052 -
081053 -
081054 -
081055 -
081057 - ..
0811 -
0812 -
0813 - Progress ref SDS 0 MN98
0814 -
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
081404 -
081405 - Follow up ref SDS 44 HY6O, ref SDS 41 VY6H.
081406 -
081407 - Submitted letter to Karen saying...
081408 -
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.
081442 -
081443 -
081444 -
0815 -
SUBJECTS
Lipids Triglycerides TG Rise HDL Declines CAD CVD Risk Rises Conflic
3103 -
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
310406 -
310407 -
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
310424 -
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
310439 -
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.
310486 -
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?
310507 -
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
310531 -
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
310549 -
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
310556 -
310557 -
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.
310570 -
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
310604 -
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?
310617 -
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?
310629 -
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
310692 -
310693 -
310694 -
310695 -
3107 -
SUBJECTS
Atorvastatin 40 MG Started 4-week Trial Test Side Effects Before Add
5503 -
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
550406 -
550407 -
550408 - Letter to medical team continues...
550409 -
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.
550425 -
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
550437 -
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,
550474 -
550480 -
550481 -
550482 -
5505 -
SUBJECTS
Atorvastatin 10 MG 4-week Trial VA Treatment Plan Test Side Effects
8603 -
8604 - 1516
860501 - ..
860502 - Work Plan Atorvastan 4-week Trial then Add Ezetimibe
860503 - Karen Coordinated Communications Starting Trial Atorvastatin
860504 -
860505 -
860506 - Received letter from Karen saying...
860507 -
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,
860515 -
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.
860519 -
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:
860537 -
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
860547 -
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
860559 -
860560 -
860561 -
860562 -
8606 -
SUBJECTS
Atorvastatin 10 MG 4-week Trial VA Treatment Plan Test Side Effects
AK03 -
AK0401 - ..
AK0402 - Clinical Trial PCSK9 VA Conctact UCSF Resolve Hyperlipidemia
AK0403 -
AK0404 -
AK0405 - Karen's letter continues...
AK0406 -
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
AK0416 -
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
AK0422 -
AK0423 -
AK0424 -
AK05 -
SUBJECTS
Atorvastatin 10 MG Ezetimibe Zeita 10 MB Research Lowers Hyperlipide
B903 -
B90401 - ..
B90402 - Ezetimibe (Zetia) with Atorvastatin Promising Lower CVD Risk Hyperlipidemia
B90403 - Atorvastatin with Ezetimibe (Zetia) Promising Lower CVD Risk Hyperlipidemia
B90404 -
B90405 - Research shows Zetia has been used successfully combined with
B90406 - Atvorstatin, shown in paper at...
B90407 -
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)
B90415 -
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.
B90462 -
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
B90499 -
B90500 -
B90502 - ..
B90503 - Another article shows...
B90504 -
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
B90520 -
B90521 -
B90522 - A Prospective, Randomized, Double-Blind Trial
B90523 -
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 cmb@bcm.tmc.edu
B90543 -
B90544 -
B90545 - 1. Abstract
B90546 -
B90547 - 1. Background
B90548 -
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.
B90556 -
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
B90561 -
B90562 -
B90563 - 2. Methods and Results
B90564 -
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
B90601 -
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
B90616 -
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.
B90689 -
B90690 -
B90691 -
B90692 -
B90693 -
B90694 -
B90695 -
B90696 -
B90697 -
B907 -
SUBJECTS
Ezetimibe Zeita Side Effects Similar Atorvastatin
BQ03 -
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
BQ0405 -
BQ0406 - Atorvastatin side effects are listed in the record on 130603 0930.
BQ0407 - ref SDS 35 PC6O
BQ0408 -
BQ0409 - Research indicates Ezetimibe has similar side effects, suggesting
BQ0410 - compounding effect...
BQ0411 -
BQ0412 - Drugs.Com
BQ0414 - ..
BQ0415 - Ezetimibe Side Effects
BQ0416 -
BQ0417 - http://www.drugs.com/sfx/ezetimibe-side-effects.html
BQ0419 - ..
BQ0420 - General Comprehensive Listing...
BQ0421 -
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
BQ0454 -
BQ0455 - 1. Fever
BQ0456 - 2. Headache
BQ0457 - 3. Muscle pain
BQ0458 - 4. Runny nose
BQ0459 - 5. Sore throat
BQ0461 - ..
BQ0462 - Less Common
BQ0463 -
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...
BQ0495 -
BQ0496 - -Continue physical activity and low fat/low cholesterol diet.
BQ0497 -
BQ0498 - -RTC in 4 weeks
BQ0499 -
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
BQ0510 -
BQ0511 - http://profiles.ucsf.edu/daniel.bikle
BQ0512 -
BQ0513 -
BQ0514 -
BQ0515 -
BQ0516 -
BQ06 -
SUBJECTS
Atorvastatin 10 MG 4-week Trial VA Treatment Plan Test Side Effects
CS03 -
CS04 - 1702
CS0501 - ..
CS0502 - VA Confirm Work Plan Atorvastan 4-week Trial then Add Ezetimibe
CS0503 -
CS0504 -
CS0505 - Received letter from Doctor Alba saying...
CS0506 -
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.
CS0523 -
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 .
CS0537 -
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
CS0548 -
CS0553 -
CS0554 -
CS0555 -
CS0556 -
CS0557 -
CS06 -
SUBJECTS
Chia Seeds Implement Recommend Manage Cholesterol Weight Energy Comm
DE03 -
DE04 - 2006
DE0501 - ..
DE0502 - Letter to Karen says...
DE0503 -
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...
DE0549 -
DE0550 - 6. Didn't notice any change in taste, so Chia seeds seem benign.
DE0551 - Thanks for the tip.
DE0552 -
DE0558 -
DE0559 -
DE0560 -
DE06 -
DE07 -
DE0701 -
DE08 -
SUBJECTS
Notify VA Implement Prescription Atorvastatin 10 MG 4-week Trial VA
EN03 -
EN04 - 2048
EN0501 - ..
EN0502 - Notify Doctor Alba Implement Prescription Atorvastatin Manage Cholesterol
EN0503 -
EN0504 - Letter submitted to Doctor Alba saying...
EN0505 -
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.
EN0548 -
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
EN0559 -
EN0565 -
EN0566 -
EN0567 -
EN06 -
SUBJECTS
LDL < 70 Not Effective Goal Avoid Arterialsclorosis CVD CAD Manage C E6
FG03 -
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
FG0404 -
FG0405 - Follow up ref SDS 2 P95F.
FG0406 -
FG0407 - Cholesterol was reviewed previously caring for Millie, reported on
FG0408 - 081226 0930. ref SDS 2 HK8O
FG0410 - ..
FG0411 - Found writing on the Internet....
FG0412 -
FG0413 - 1. Tim Russert's Fatal Heart Attack Was Preventable, He Followed
FG0414 - Antiquated Advice
FG0416 - ..
FG0417 - Date............................. no date
FG0418 -
FG0419 - http://livinlavidalowcarb.com/blog/tim-russerts-fatal-heart-attack-was-preventable-he-followed-antiquated-advice/2403
FG0420 -
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:
FG0453 -
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?
FG0491 -
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
FG0498 -
FG0499 -
FG0500 - 8. Check out Tim Russert's lipid profile:
FG0501 -
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
FG0540 -
FG0541 -
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.
FG0558 -
FG0560 - ..
FG0561 - Article Tim Russert's Fatal Heart Attack Preventable continued...
FG0562 -
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.
FG0572 -
FG0573 -
FG0574 -
FG0575 -
FG06 -
SUBJECTS
Cholesterol Research Internet Low Carbohydrate Diet Lower Triglyceri
GL03 -
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
GL0406 -
GL0407 - Author reports personal lipid profile similar to lab on 131015 0724.
GL0408 - ref SDS 38 IM9N
GL0409 -
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.
GL0430 -
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
GL0463 -
GL0464 -
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
GL0470 -
GL0471 -
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.
GL0481 -
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
GL0512 -
GL0513 -
GL0514 -
GL0515 -
GL06 -
SUBJECTS
Doc's Opinion Axel F Sigurdsson Research Internet Arterialsclorosis
HD03 -
HD0401 - ..
HD0402 - Cholesterol Bound Atherogenic Lipoproteins Causes Aterialsclorosis
HD0403 -
HD0404 -
HD0405 - Another article says...
HD0406 -
HD0407 - 2. Doc's Opinion
HD0408 -
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
HD0421 -
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
HD0449 -
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
HD0485 -
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.
HD0499 -
HD0500 -
HD0501 -
HD06 -
SUBJECTS
Doc's Opinion Axel F Sigurdsson Research Internet Arterialsclorosis
I603 -
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
I60406 -
I60407 -
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.
I60436 -
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.
I60459 -
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
I60476 -
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
I60483 -
I60484 -
I60485 - Large Fluffy LDL Particles Protective 300% Lower Risk than Small Dense LDL
I60486 -
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
I60524 -
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.
I60547 -
I60548 -
I60549 -
I606 -
SUBJECTS
Doc's Opinion Axel F Sigurdsson Research Internet Metabolic Syndrome
J003 -
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
J00406 -
J00407 -
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.
J00418 -
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.
J00432 -
J00433 -
J00434 -
J005 -
SUBJECTS
Doc's Opinion Axel F Sigurdsson Research Internet Arterialsclorosis
K103 -
K10401 - ..
K10402 - LDL-C Lower Statins Misleading Don't Lower LDL-P ApoB
K10403 - Statin Medication Lowers LDL-C More than LDL-P Misleading
K10404 -
K10405 -
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
K10414 -
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
K10428 -
K10429 -
K10430 -
K10431 -
K10432 -
K10433 -
K105 -
SUBJECTS
Eating Academy Peter Attia MD Research Internet Arterialsclorosis Ch
LB03 -
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
LB0406 -
LB0407 -
LB0408 - Exercise Lowers LDL-P
LB0409 -
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.
LB0415 -
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
LB0432 -
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
LB0438 -
LB0439 -
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.
LB0446 -
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...
LB0473 -
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?
LB0482 -
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
LB0489 -
LB0490 -
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
LB0525 -
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...
LB0532 -
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
LB0545 -
LB0546 -
LB0547 -
LB06 -
SUBJECTS
Doc's Opinion Axel F Sigurdsson MD Research Internet Arterialscloros
MK03 -
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
MK0406 -
MK0407 -
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.
MK0421 -
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
MK0428 -
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
MK0456 -
MK0457 -
MK0459 - ..
MK0460 - Diagram LDL Particle Count Higher Triglycerides Rich/Cholesterol Depleted
MK0461 -
MK0462 -
MK0463 - Doctor Sigurdsson cites another source on Internet with PDF
MK0464 - diagrams...
MK0465 -
MK0466 - 3. Relationship of LDL-C & LDL-P