Guest guest Posted August 29, 2012 Report Share Posted August 29, 2012 #1, does this person have disease (subclinical)? (identified by pos CAC scoring, plaque on carotid US, or calcifications on any other radiologic films?#2, what kind of diet is she on, based on the panel, i am guessing she eats low carb and mod-hi fat. This type of panel often will come up on patients eating this way. #3, Is she inflamed ? are markers of inflammation elevated?in another words chol is just risk, tells us nothing about disease, need more inforocky Rakesh C. Patel, M.D.Twitter: @drrcpatelwww.facebook.com/azsunfmwww.medleyhealth.com/rakeshpatelwww.azprevention.comArizona Sun Family Medicine, P.C. and Nexlev Health and FitnessSpecializing in Diabetes, Heart Attack and Stroke Prevention633 E. Ray Road #101Gilbert, AZ 85296www.azsunfm.com and www.nexlev.com To: " " < > Sent: Wednesday, August 29, 2012 9:11 AM Subject: Re: Cholesterol Question I've had good success w pantethine 300mg tid and if tolerated immediate release niacin starting low, like 50mg working up to 500mg bid tid watching lfts.Sent from my iPhone 56 year old woman with: Tchol 330 LDL 244 HDL 76 TAG 50 POS FH CAD Stable for years in this range. Failed Red Yeast Rice (won't take statins) Did try Lipitor once with little change in #s Umm . . . ideas? Pamela Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2012 Report Share Posted August 29, 2012 Consider the VAP or Berkely to help clarify pattern and therapy also? To: " " < > Sent: Wednesday, August 29, 2012 11:57 AM Subject: Re: Cholesterol Question #1, does this person have disease (subclinical)? (identified by pos CAC scoring, plaque on carotid US, or calcifications on any other radiologic films?#2, what kind of diet is she on, based on the panel, i am guessing she eats low carb and mod-hi fat. This type of panel often will come up on patients eating this way. #3, Is she inflamed ? are markers of inflammation elevated?in another words chol is just risk, tells us nothing about disease, need more inforocky Rakesh C. Patel, M.D.Twitter: @drrcpatelwww.facebook.com/azsunfmwww.medleyhealth.com/rakeshpatelwww.azprevention.comArizona Sun Family Medicine, P.C. and Nexlev Health and FitnessSpecializing in Diabetes, Heart Attack and Stroke Prevention633 E. Ray Road #101Gilbert, AZ 85296www.azsunfm.com and www.nexlev.com To: " " < > Sent: Wednesday, August 29, 2012 9:11 AM Subject: Re: Cholesterol Question I've had good success w pantethine 300mg tid and if tolerated immediate release niacin starting low, like 50mg working up to 500mg bid tid watching lfts.Sent from my iPhone 56 year old woman with: Tchol 330 LDL 244 HDL 76 TAG 50 POS FH CAD Stable for years in this range. Failed Red Yeast Rice (won't take statins) Did try Lipitor once with little change in #s Umm . . . ideas? Pamela Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2012 Report Share Posted August 29, 2012 Looking at her profile, this patient will be pattern A with hi APOB or ldl-PRakesh C. Patel, M.D.Twitter: @drrcpatelwww.facebook.com/azsunfmwww.medleyhealth.com/rakeshpatelwww.azprevention.comArizona Sun Family Medicine, P.C. and Nexlev Health and FitnessSpecializing in Diabetes, Heart Attack and Stroke Prevention633 E. Ray Road #101Gilbert, AZ 85296www.azsunfm.com and www.nexlev.com To: " " < > Sent: Wednesday, August 29, 2012 11:48 AM Subject: Re: Cholesterol Question Consider the VAP or Berkely to help clarify pattern and therapy also? To: " " < > Sent: Wednesday, August 29, 2012 11:57 AM Subject: Re: Cholesterol Question #1, does this person have disease (subclinical)? (identified by pos CAC scoring, plaque on carotid US, or calcifications on any other radiologic films?#2, what kind of diet is she on, based on the panel, i am guessing she eats low carb and mod-hi fat. This type of panel often will come up on patients eating this way. #3, Is she inflamed ? are markers of inflammation elevated?in another words chol is just risk, tells us nothing about disease, need more inforocky Rakesh C. Patel, M.D.Twitter: @drrcpatelwww.facebook.com/azsunfmwww.medleyhealth.com/rakeshpatelwww.azprevention.comArizona Sun Family Medicine, P.C. and Nexlev Health and FitnessSpecializing in Diabetes, Heart Attack and Stroke Prevention633 E. Ray Road #101Gilbert, AZ 85296www.azsunfm.com and www.nexlev.com To: " " < > Sent: Wednesday, August 29, 2012 9:11 AM Subject: Re: Cholesterol Question I've had good success w pantethine 300mg tid and if tolerated immediate release niacin starting low, like 50mg working up to 500mg bid tid watching lfts.Sent from my iPhone 56 year old woman with: Tchol 330 LDL 244 HDL 76 TAG 50 POS FH CAD Stable for years in this range. Failed Red Yeast Rice (won't take statins) Did try Lipitor once with little change in #s Umm . . . ideas? Pamela Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 29, 2012 Report Share Posted August 29, 2012 Tried dieting? Any other risk factors? > 56 year old woman with: > > Tchol 330 > > LDL 244 > > HDL 76 > > TAG 50 > > POS FH CAD > > Stable for years in this range. > > Failed Red Yeast Rice (won't take statins) > Did try Lipitor once with little change in #s > > Umm . . . ideas? > > > > Pamela > > > > ------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2012 Report Share Posted August 30, 2012 Cholesterol levels are just numbers. Absolute reduction in primary events with the use of statins is 1%. So for every 100 patients you put on statins, only 1 will benefit. Statins are almost worthless and using lipid panels to determine if they are effective even more so. My suggestion. Get a heartscan - calcium score and further stratify her risk. Get a VAP or NMR lipid test. Get an omega-3 index test Switch her to a Paleo diet. Steve stown, NJ > > 56 year old woman with: > > Tchol 330 > > LDL 244 > > HDL 76 > > TAG 50 > > POS FH CAD > > Stable for years in this range. > > Failed Red Yeast Rice (won't take statins) > Did try Lipitor once with little change in #s > > Umm . . . ideas? > > > > Pamela > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2012 Report Share Posted August 30, 2012 Pretty much agree with Steve re: Lipids...disagree with all the other suggestions...Paleo diet ...oh brother....maybe running after the food like our ancestors would help. > > > > 56 year old woman with: > > > > Tchol 330 > > > > LDL 244 > > > > HDL 76 > > > > TAG 50 > > > > POS FH CAD > > > > Stable for years in this range. > > > > Failed Red Yeast Rice (won't take statins) > > Did try Lipitor once with little change in #s > > > > Umm . . . ideas? > > > > > > > > Pamela > > > Quote Link to comment Share on other sites More sharing options...
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