Intolerant of statins? | Cardiology | 08-2010
I find that many patients who say they can t tolerate statins can in fact tolerate low doses, either halving the daily dose or taking their therapy 3 days a ...
You are what you eat… or are you? | Cardiology | 02-2010
This is a controversial area. There is older literature that suggests that dietary cholesterol does increase in serum values. While it s not accepted by all, cholesterol content of food ...
Statins: safer than aspirin | Cardiology, Clinical Pharmacology | 01-2010
Cardiologist s response Sadly, in real life, arthritis and aches and pains are all too commonly present in the background of high-risk patients. But muscle ache shouldn t preclude statin ...
Can good HDL make up for bad LDL? | Cardiology | 10-2009
It sounds like you are wisely assessing the patient s global risk based on all cardiovascular risk factors. High HDL cholesterol is indeed protective, of course. But this effect needs ...
Binge eating and cholesterol | Cardiology | 10-2009
I doubt that heavy holiday meals would make a very big difference in lipid profile for the majority of your patients, mainly because the people who tend to overindulge during ...
Reacting to JUPITER | Cardiology | 06-2009
The JUPITER trial is a landmark paper looking at 17,802 patients who were randomized to receive rosuvastatin 20 mg day or a placebo. Primary end points included fatal and nonfatal ...
Is this a statin side effect? | Clinical Pharmacology, Cardiology | 05-2009
Muscular adverse effects are very common with statins, and indeed are the most frequent reason for cessation or alteration of statin therapy. Statin-induced myopathy remains an issue of concern, with ...
Acne Tx and cholesterol | Dermatology, Cardiology | 04-2009
Cardiology response A short-term use of this medication as you state will have a very limited role in the development of future atherosclerosis and is not a major concern. As ...
Cutting LDL is job one | Cardiology | 04-2009
I believe that controlling LDL cholesterol to target values is our first priority. The drugs most effective at achieving this are statins, usually at higher doses than many physicians and ...
Can cholesterol be too low? | Endocrinology | 03-2009
Very low concentrations of LDL-C can be seen with genetic defects that result in apolipoprotein B deficiency hypobetalipoproteinemia and abetalipoproteinemia . Patients with abetalipoproteinemia can have peripheral neuropathies.
Gall bladder surgery and lipids | Gastroenterology | 03-2009
I rsquo ve never heard of cholecystectomy affecting lipid metabolism. Gall stone disease is sometimes thought of as a disease of the liver mdash where cholesterol and bile acid synthesis ...
Should we worry about triglycerides? | Cardiology | 02-2009
Elevated triglycerides are indeed considered an independent risk factor for ischemic heart disease. While there are no particles called triglycerides, there are triglyceride-rich mostly remnant particles that do cause atherosclerosis. ...
Is low HDL-C really a risk factor? | Cardiology | 07-2008
The number one lipid target is still LDL-C, and this should be treated first, especially in high-risk patients. In those with very high risk, I aim for a value 2.0 ...
The link between dandruff, acne and oily skin | Dermatology | 06-2008
Each of these conditions is due to the interaction between a lipophilic yeast organism and a host immune response. As sebum is unique to each individual in its blend of ...
When hypothyroidism lies below the radar | Endocrinology | 05-2008
For patients who have subclinical hypothyroidism combined with thyroid autoimmunity or hypercholesterolemia or heart disease, treatment is warranted. For others, a trial of 3-6 months of watchful waiting for symptoms ...
Statins improve cardiac pain | Clinical Pharmacology, Cardiology | 03-2008
There's no data to suggest that carditis or cardiac pain are caused by statin therapy. In fact, the opposite has been found to be true. Randomized trials on subjects with ...
Statins improve cardiac pain | Cardiology, Clinical Pharmacology | 03-2008
Adverse statin effects on muscle are confined to skeletal muscle, usually in the legs, arms and back, with chest pain being uncommon. The myalgias produced by such drugs are unique ...
Can statins be used in patients with liver disease? | Gastroenterology | 01-2008
Although statins can occasionally cause liver enzyme elevation, they're thought to be fairly safe in stable chronic liver disease. They may in fact be indicated in non-alcoholic fatty liver disease ...
Can statins be used in patients with liver disease? | Clinical Pharmacology, Gastroenterology | 01-2008
The use of statins in patients with liver disease and elevated blood lipids usually has a positive risk benefit ratio if it's part of a strategy including addressing lifestyle issues ...
What's the evidence for statins in prevention? | Cardiology | 11-2007
There are multiple trials that demonstrate the value of statins in high-risk primary prevention, e.g. the West of Scotland Coronary Prevention Study WOSCOPS with pravastatin. The Anglo-Scandinavian Cardiac Outcomes Trial ...
Can warfarin affect statin therapy? | Clinical Pharmacology | 11-2007
The concurrent use of allopurinol and warfarin has been described, primarily in case reports, to produce enhanced anticoagulation activity as measured by a prolonged prothrombin time. The mechanism for this ...
Case study: starting statins | Cardiology | 05-2007
The guidelines are simply that just guidelines. They should never replace clinical practice. You've detected 2 very important determinants of risk -- a positive family history at a very early ...
Pruritus in the elderly | Dermatology | 12-2006
Itching in the elderly is a common presentation, and finding the cause and a tolerable treatment can be distressing for both patient and physician. I find the best way to ...
Anorexia nervosa: why the excess cholesterol? | Endocrinology | 11-2006
The etiology of hypercholesterolemia in anorexia nervosa patients hasn't been fully elucidated. It's currently believed to be the result of decreased biliary and fecal excretion of cholesterol and bile acids. ...
Anorexia nervosa: why the excess cholesterol? | Gastroenterology | 11-2006
Rapid weight loss, from whatever cause, can induce cholesterol gallstones as opposed to pigment stones by at least two mechanisms. There may be excessive secretion of cholesterol in the bile ...
Lipids and the positive power of nuts | Cardiology | 09-2006
Nuts may be beneficial to the heart, despite previous concerns that their high fat content makes them unsuitable for those at high risk of cardiovascular disease. Certain substances may explain ...
When is LDL-C too low? | Cardiology | 09-2006
How low to go is a moving target. Beginning in 2006, the Canadian Consensus guidelines on high cholesterol now recommend a LDL-C measurement of below 2.0 mmol L in very ...
Should statins stop in the presence of myalgia? | Cardiology | 08-2006
Unfortunately, myalgias and arthritis are common, especially as we age. Many patients and pharmacists are quick to blame statins for these muscular complaints. Before starting anyone on a medication to ...
Elevated CK: limit statins? | Nephrology | 08-2006
If the baseline CK is elevated, evaluate the possibility of hypothyroidism with a test for thyroid-stimulating hormone. At times, mild elevation in CK may be related to physical activity, i.e. ...
When to treat isolated high cholesterol | Cardiology | 04-2006
As you're well aware, cholesterol and other factors need to be interpreted in the face of global risk. Framingham data is probably the best source to calculate a 10-year likelihood ...
Can we pre-empt heart disease with drugs? | Cardiology | 01-2006
As you're well aware, we all have many patients who are at risk for future vascular events, so clinical judgement is extremely important. In many high-risk individuals, the use of ...
Diabetic angioedema: preventing renal damage | Cardiology | 11-2005
The Canadian Diabetes Association has recently changed its guidelines for the treatment of type 2 diabetes. Cardiovascular disease is responsible for 60-75 of mortality in this population. Some experts feel ...
Do statins and fibrates have pleomorphic effects? | Cardiology | 10-2005
It's clear that the major effect of statins is on low-density lipoprotein cholesterol. Standard dose therapy can decrease cardiovascular events by at least one-third. Many experts for years have contended ...
Are gallbladder polyps significant? | Gastroenterology | 10-2005
Most gallbladder polyps aren't true polyps. They're almost always discovered on ultrasound examination. Typically, they're adenomatous hyperplasia, cholesterol polyps and inflammatory polyps. True polyps are adenomas and can be single ...
Are gallbladder polyps significant? | Imaging | 10-2005
Gallbladder polyps are a common incidental finding on abdominal ultrasound US exams performed for other reasons. Prevalence rates for these polyps have been estimated at 4-8 of the population. The ...
What's a safe limit for high HDL? | Cardiology | 07-2005
There is no safe upper limit for HDL or any other cardiovascular risk factor. Clinically, the first step is to calculate a score for total risk factors, using the Framingham ...
Is there a need for over-the-counter statins? | Cardiology | 07-2005
Currently, the Canadian guidelines on high cholesterol suggest treating patients by first calculating their 10-year risk of a vascular event using the Framingham formula. amp lt br amp gt amp ...
Do leg cramps foreshadow vascular events? | Cardiology | 07-2005
Leg cramps and night cramps are quite common, but they're not affected by cholesterol medication. Cramps that occur with walking are suggestive of blocked arteries to the lower extremities and ...
Red flags in gallbladder polyps | Gastroenterology | 07-2005
I agree, most gallbladder polyps are benign. Indeed, many of them aren't true polyps at all, e.g. cholesterol polyps, inflammatory polyps, etc. True adenomas are rare, and the adenoma-carcinoma sequence ...
CV events with normal lipids or menopause | Cardiology | 04-2005
Lipid parameters constitute only one of the five major CV risk factors. It's very clear that in some patients, the cholesterol profile contributes little to the atherosclerosis. Also, there's no ...
Psychiatric compliance advice | Psychiatry | 02-2005
Certainly, education is very important for all psychiatric patients. Too often, individuals and even clinicians don't have a clear idea of how medication is to be used. Patients may change ...
What's behind hypertensive response to exercise? | Cardiology | 12-2004
The classic definition of hypertension is an office blood pressure BP reading greater than 140 90 mm Hg, measured on at least 3-5 occasions. This is a controversial area, however. ...
Anti-obesity vs lipid-lowering drugs | Endocrinology | 11-2004
Orlistat is a lipase inhibitor that leads to malabsorption of fat to such a degree that weight loss is expected if taken regularly. It can cause significant gastrointestinal side effects ...
What does C-reactive protein predict? | Cardiology | 09-2004
C-reactive protein CRP was first described in the 1950s and has now become popularized by cardiologist Paul Ridker, whose expertise is in arterial inflammation. This protein, an indicator of low-level ...
What drugs lower lipids in familial lipidemias? | Cardiology | 06-2004
One of the two most common forms of familial hyperlipidemia is familial hypercholesterolemia, where patients have a total cholesterol and low-density lipoprotein LDL that are markedly elevated. Usually, the total ...
Which antiplatelet is best? | Cardiology | 06-2004
Antiplatelet therapy such as ASA decreases cardiovascular events in the order of 25 . In the trial of Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events CAPRI , ...
What's normal cholesterol? | Hematology | 05-2004
Laboratories shouldn't report normal values for serum cholesterol, and in fact, 5.2 or 6.2 aren't. The causal relation of hypercholesterolemia with atherosclerosis such as coronary artery disease CAD , peripheral ...
Should I worry about gallbladder polyps? | Gastroenterology | 04-2004
Gallbladder polyps are often reported on ultrasound examinations. They're asymptomatic and don't need to be followed. A large one e.g. greater than 1 cm is probably worth investigating -- it ...
C-reactive protein: useful marker for CVD? | Cardiology | 03-2004
Studies conducted in healthy men and women show that a single measurement of CRP is a valuable predictor for future vascular events beyond conventional cardiac risk factors. CRP levels are ...
Targeting cholesterol levels in low-risk patients | Cardiology | 02-2004
The Canadian Clinical Practice Guidelines on cholesterol management will be updated this year. They will most likely state that in low-risk patients -- such as you've described -- the target ...
Fibrates does one dose fit all? | Cardiology | 02-2004
Fibrates are an interesting class of drugs that are metabolized by the kidneys. They don't have the same dose relationship as other classes of cholesterol medications there's little additional benefit ...
The right blood tests to monitor atypical antipsychotics | Psychiatry | 10-2003
It's a good idea to perform some basic tests prior to initiating treatment with an atypical antipsychotic. These include assessing thyroid and liver function and measuring blood glucose, triglyceride and ...
The lowdown on ezetimibe for lipid lowering | Cardiology | 09-2003
Ezetimibe belongs to a new class of cholesterol-lowering medications that blocks a transporter mechanism in the intestinal wall. Cholesterol metabolism is extremely complex, but by preventing absorption at this site, ...
Are gallbladder polyps a concern? | Gastroenterology | 07-2003
Most of the time, these are either cholesterol polyps cholesterol crystals and macrophages or adenomatous hyperplasia -- they aren't true polyps. True adenomas do occur, but they're not considered worrisome ...
CRP: a hot topic in cardiology | Cardiology | 05-2003
CRP is a marker of micro-inflammation and is currently the hottest topic in prevention. Since atherosclerosis is an inflammatory process, measuring CRP may provide additional predictive value beyond conventional risk ...
Are we ready for homocysteine therapy? | Cardiology | 05-2003
It s well known that patients with high homocysteine have a greater risk of cardiovascular disease -- a risk that doubles in those whose levels are 10-15 umol L. High ...
Hypothyroidism's effects on lipid parameters | Endocrinology | 04-2003
Low-density lipoprotein cholesterol LDL-C is often elevated in hypothyroidism, likely due to decreased hepatic expression of LDL receptors. Fortunately, it's corrected by treating the hypothyroidism. This condition may also lower ...
High CVD risk, low LDL-C will statins help? | Endocrinology | 04-2003
The HPS didn't include patients with a total cholesterol of amp lt 3.5 mmol L, though some patients did have LDL-C amp lt 3.0 mmol L. This makes it difficult ...
ApoB: not ready for prime time | Cardiology | 03-2003
ApoB is a better marker than LDL cholesterol at predicting atherosclerosis, but the test isn't well standardized yet, and many assays exist. At this point, we can't recommend it for ...
Can chitosan help dialysis patients? | Nephrology | 03-2003
Actually, there isn't amp quot ample amp quot evidence at presentin peer-reviewed published literature that can support the widespread use of thisagent. Further studies are required to establish chitosan's efficacy ...
Cholesterol: how low is too low? | Cardiology | 02-2003
By Canadian standards, these values are low, but if this person lived in rural China these values would be average. Roughly 50 of North Americans will die from vascular disease ...
Young woman, low HDL, scary family history | Cardiology | 01-2003
Low HDL cholesterol is a marker for vascular disease. In addition, you've discovered a scary family history. My advice is to refer her to someone interested in dealing with prevention ...
Muscle soreness: is the statin to blame? | Cardiology | 01-2003
You've described a group of patients all too common to many physicians. I divide these patients into three groups Muscle soreness and normal CKs the most common Randomized, placebo-controlled trials ...
What do gallbladder polyps mean? | Gastroenterology | 01-2003
Gallbladder polyps don't cause symptoms and are usually of no consequence. Most are adenomatous hyperplasia and cholesterol polyps, so they don't have any malignant potential. True adenomas can occur, but ...
Impaired glucose tolerance: any lipid targets? | Cardiology | 12-2002
The Canadian consensus on high cholesterol doesn't have a specific category yet for impaired glucose intolerance. Depending on other risk factors, however, I'll usually classify these patients as intermediate in ...
Does high HDL cancel out high LDL? | Cardiology | 11-2002
Your patient has clear evidence of vascular disease. Despite a very high HDL, she may have blocked arteries, so I'd aim for an LDL cholesterol of 2.5 mmol L or ...
Monitoring mood stabilizers + risperidone | Psychiatry | 11-2002
No specific lab monitoring needs to be done for the risperidone. It's useful to test blood glucose, triglycerides and cholesterol periodically. For the mood stabilizers, the following are recommended every ...
WINNING COMBOS OF LIPID AGENTS | Cardiology | 09-2002
In certain high-risk patients, combining multiple lipid agents makes clinical sense. For instance, in patients with diabetes and atherosclerosis, a good dose of the statin lowers total cholesterol and LDL ...
STATINS FOR EVERYONE WITH VASCULAR DISEASE? | Cardiology | 08-2002
All patients with vascular disease should have an assessment of their lipid status. Ideally, blood work should be done after fasting. Most recently, we've seen many trials demonstrating clear and ...
Dealing with isolated low HDL | Cardiology | 05-2002
Patients with isolated low HDL cholesterol -- less than 0.9 mmol L -- are indeed at significant cardiovascular risk. And if they already have diabetes and hypertension, in addition to ...
SCREENING FOR FAMILIAL LIPID DISORDERS | Cardiology | 02-2002
Patients who have known familial hypercholesterolemia -- cholesterol in the 8-10 mmol L range -- should certainly be screened as they enter school. In fact, the diagnosis can be made ...
ROLE OF METFORMIN IN INSULIN RESISTANCE | Endocrinology | 02-2002
I'm not sure if we're discussing a patient diagnosed with Type 2 diabetes mellitus, or one who's at risk of developing diabetes. In the case of patients with diet-controlled Type ...
DO STATINS STRENGTHEN BONES? | Rheumatology | 01-2002
Inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A HMG CoA reductase appear to stimulate bone formation in rodents, both in vitro and in vivo. The effect is partially the result of increased expression ...
PUZZLED BY HIGH MMA + NORMAL B12 | Hematology | 12-2001
MMA or methylmalonyl-CoA is an intermediary product formed in the breakdown of several essential amino acids isoleucine, valine, methionine, threonine , odd-chain fatty acids and cholesterol. A form of vitamin ...
LONGER LIFE WITH STATINS? | Cardiology | 10-2001
I always find these questions quite difficult because the answer involves modelling, which is open to biases. What I can tell you with confidence is that clinical trials, in both ...
WHEN LDL WON'T FALL WITH STATINS | Cardiology | 09-2001
For LDL reduction, 80 mg of simvastatin is almost as effective as 40 mg of atorvastatin, and they both cost just over 2.00 per day. You could go to atorvastatin ...
WINNING TACTICS IN BATTLING CVD | Cardiology | 09-2001
CVD is indeed a leading cause of death in our society, accounting for just under 50 of total mortality. Conventional risk factors such as high blood pressure and elevated cholesterol ...
STATINS OR FIBRATES: WHICH LIPIDS BENEFIT? | Cardiology | 08-2001
Most practitioners of evidence-based medicine are using statins in patients with predominantly high LDL values. It's also clear that in patients with triglycerides amp gt 2 mmol L along with ...
TAMOXIFEN VS CAD: HELP OR HARM? | Cardiology | 06-2001
Tamoxifen, as you know, leads to a favourable lipid profile. Similarly, hormone replacement therapy HRT also produces a good lipid profile by lowering LDL low-density lipoprotein and boosting HDL high-density ...
THE ABCs OF COMPLEX ATHEROSCLEROSIS | Cardiology | 05-2001
Atherosclerosis is a complex disease requiring multiple interventions. The foundation of good health is still diet and exercise with appropriate medications. Just think of the ABCs 1 A is for ...
