Cholesterol Studies and Treatment in the News
(September 8, 2015) The Elusive, Less Recognized Side Effect of Statins!
I guess it was a good thing in the 1990's, when 3 different drug companies constructed a testing protocol to assess the value of their statin product. The undertaking was huge, many years and thousands of patients. These studies were deemed "outcome studies," and repeatedly showed the 30% reduction in subsequent coronary artery disease when statins were started.
What's not such a good thing is that these outcome projects are ridiculously expensive, and time consuming. A recent outcome study required 7 years (maybe 25% of a physician's career) and 17,000 patients. Perhaps we're looking at a compromised system, when only drug companies can afford the testing, and when so many patients and doctor have to wait. And we're being asked to apply the results of a "composite" of thousands of patients to the single patient we're treating. Lipidologists don't think this way!
Studies in the 1970's and 1980's were usually much more "confined." We used past experience,studies large and small, observation, theory, even intuition, in constructing a "best medical judgement." Good doctors did this well and had good results.
We don't see so much of this now in conventional treatment of cholesterol, as providers defer to the results of outcome studies Lots of research since the statin surge of the 1990's has yielded lots of improvement for patients treated by lipidologists and like minded providers who include, but restricted to outcome studies.
But the over reliance on statin outcome studies has retarded progress...an ironic side effect of statins!
Dr. Mickle's Response to the Zetia Study
On November 17, 2014, research was presented to the American Heart Association that Zetia (ezetimibe) reduced artery disease in addition to its
known benefit of reducing cholesterol. Happily, many providers will now add Zetia to their treatment of elevated cholesterol. Happily, they'll join the thinking providers who've offered their patients Zetia over the past decade, confident in their medical judgement that Zetia could improve the dismal 35% success rate that statins have offered (and Zetia accomplishes this with very little risk of side effects).
Unhappily, many patients suffered while their providers waited for difficult "outcome" studies instead of relying on scientific plausibility (any previous cholesterol lowering has resulted in disease lowering), clinical experience, recent clinical research, smaller studies, and even basic science research.
The lesson here is that providers will best serve their patients when they consider all information, not simply "outcome studies," and when they establish their best medical judgement decisions. The comfort that this study offers is of little consolation to patients and their families who could have had additional help from Zetia over the past decades.
Dr. Mickle's Advice to Patients
Regarding the July, 2014 New England Journal of Medicine Niacin Study
Niacin has been impugned recently in a seemingly continuous attempt to diminish its value in preventing artery disease, dating back to May, 2011. There are so many problems with these reports, that cholesterol specialists are confused with the apparent disregard of all the salutary effects of niacin that have been well known since the 1980's.
Niacin is alive and well, and will outlive these articles, and likely the authors who prepare them!
As a lipidologist with a longstanding habit of reading medical literature and studies critically, I have a number of questions about the relevance of the NIH study to every day practice, where we see patients with a wide variety of conditions and use supplements in conjunction with prescription medicines. For example, perhaps the study was not continued long enough (initially intended as a 5-year study, it was discontinued after three-and-a-half years). Perhaps the numbers of test subjects was inadequate. But, perhaps most importantly, I wonder if the segment of the patient population treated was too narrow for us to be able to draw general conclusions. The study treated subjects whose LDL-cholesteral was already very low: their average LDL-cholesterol was only 71mg (mean population level is 130mg). Perhaps these patients had no further “room” for improvement. There are other studies in the research pipeline which look at the effects of niacin on other patient populations, and I look forward to them.
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James D. Mickle, Jr. MD opens Santa Fe Office February, 2011
James D. Mickle, Jr., MD has opened a private practice, Cholesterol Studies and Treatment, dedicated to diagnosing, halting, and reversing vascular disease. Dr. Mickle is an internationally recognized expert on advanced techniques for diagnosing and treating artery disease, the cause of the number one and number three killers of adults in the United States: heart attack and stroke.
Dr. Mickle is a graduate of the Hershey Medical School in Pennsylvania, and was practicing family medicine in the Philadelphia area when he became increasingly puzzled by inconsistencies between the standard medical approach to high cholesterol numbers and the lives of some patients. “As my patients aged, I saw how many diseases stem from cholesterol problems, and I was intrigued by some mysteries—the ninety-year-old who has high cholesterol numbers but excellent health, or the forty-year-old with good numbers who suffers a heart attack. I delved into cholesterol research, and fine-tuned care of my patients.” In 2008 Dr. Mickle became board-certified as a Clinical Lipidologist. “That’s a new specialty—a big word for someone who specializes in artery disease caused by lipids--fats such as cholesterol and triglycerides.” Dr. Mickle currently serves on the Society of Atherosclerosis Imaging and Prevention’s Advisory Council for IMT (intima-media thickness) Ultrasound in Clinical Practice. This international group is formulating new recommendations for the use of carotid artery ultrasound in assessing the state of a patient’s vascular system.
Dr. Mickle believes that the standard diagnostic and treatment protocols are far behind the latest research. For instance, “the lab test that best predicts artery disease is not the familiar LDL (‘bad’) cholesterol test, but rather a tragically under-used test called ApoB. Another underused test is the carotid artery ultrasound, which enables us to visualize the arteries and determine whether or not there is disease, not just guess at the state of patients’ arteries from their lab tests.” He has found that natural supplements, as well as diet and lifestyle changes, can be crucial to artery health. He also believes that statins (prescription cholesterol-lowering medications) are over-prescribed to some patients whose arteries prove healthy, no matter what their basic lab tests say.
Dr. Mickle has opened a practice in Santa Fe for reasons both personal and professional. “Like so many people, I have long loved New Mexico for its natural beauty, diversity, and cultural richness. I have family here, and I think that this is a community that is health-conscious, and receptive to new ideas and natural approaches, while wanting world-class health care.”
James D. Mickle, Jr. MD, Santa Fe Cholesterol Expert,
Speaks to International Physicians and Researchers in Bethesda, Maryland
Santa Fe, NM, March 23, 2011 - James D. Mickle, Jr. MD, of Cholesterol Studies and Treatment in Santa Fe, will be a speaker at the Society for Atherosclerosis Imaging and Prevention Training Academy in Bethesda, Maryland, April 14-15, 2011. These training sessions for physicians and cardiac care specialists precede the annual meeting of the Society for Atherosclerosis Imaging and Prevention in Bethesda, April 15-17.
Dr. Mickle is an internationally recognized expert in the use of carotid artery ultrasound to diagnose the presence and progression of arterial disease caused by cholesterol buildup in the arteries. Dr. Mickle says, “Ultra-sound imaging of the carotid artery enables us to visualize the actual state of a patient’s arteries, and not just guess based on cholesterol numbers. Sometimes it reveals that a patient’s arteries are plaque-free and healthy, and suggests that, even in the face of abnormal lab tests, doctors might recommend natural treatments only—supplements, diet, and exercise. When a patient does have plaque in the arteries, imaging can help guide treatment. When we see halting or reversal of disease, we know that our treatment is working.”
Dr. Mickle currently serves on the Society of Atherosclerosis Imaging and Prevention’s Council for IMT (intima-media thickness) Ultrasound in Clinical Practice. This international group is formulating new recommendations for the use of carotid artery ultrasound in assessing the state of a patient’s vascular system.
Dr. Mickle explains, “I am one of a few full-time clinicians—doctors seeing patients every day--on that panel. Other members are distinguished researchers from around the world. I was invited to participate because I have been doing carotid artery ultrasound in my office for 11 years, and had a body of experience to share with research-oriented physicians and scientists.”
Dr. Mickle is a board-certified lipidologist (cholesterol specialist) and has recently opened Cholesterol Studies and Treatment in Santa Fe, where he employs carotid artery ultrasound and advanced lab tests to assess the state of a patient’s arteries.
Cholesterol Studies and Treatment is located at 4 Calle Medico, Suite C, Santa Fe, 87505.
Call 505-699-1172, or email us at [email protected]
On November 17, 2014, research was presented to the American Heart Association that Zetia (ezetimibe) reduced artery disease in addition to its
known benefit of reducing cholesterol. Happily, many providers will now add Zetia to their treatment of elevated cholesterol. Happily, they'll join the thinking providers who've offered their patients Zetia over the past decade, confident in their medical judgement that Zetia could improve the dismal 35% success rate that statins have offered (and Zetia accomplishes this with very little risk of side effects).
Unhappily, many patients suffered while their providers waited for difficult "outcome" studies instead of relying on scientific plausibility (any previous cholesterol lowering has resulted in disease lowering), clinical experience, recent clinical research, smaller studies, and even basic science research.
The lesson here is that providers will best serve their patients when they consider all information, not simply "outcome studies," and when they establish their best medical judgement decisions. The comfort that this study offers is of little consolation to patients and their families who could have had additional help from Zetia over the past decades.
Dr. Mickle's Advice to Patients
Regarding the July, 2014 New England Journal of Medicine Niacin Study
Niacin has been impugned recently in a seemingly continuous attempt to diminish its value in preventing artery disease, dating back to May, 2011. There are so many problems with these reports, that cholesterol specialists are confused with the apparent disregard of all the salutary effects of niacin that have been well known since the 1980's.
Niacin is alive and well, and will outlive these articles, and likely the authors who prepare them!
As a lipidologist with a longstanding habit of reading medical literature and studies critically, I have a number of questions about the relevance of the NIH study to every day practice, where we see patients with a wide variety of conditions and use supplements in conjunction with prescription medicines. For example, perhaps the study was not continued long enough (initially intended as a 5-year study, it was discontinued after three-and-a-half years). Perhaps the numbers of test subjects was inadequate. But, perhaps most importantly, I wonder if the segment of the patient population treated was too narrow for us to be able to draw general conclusions. The study treated subjects whose LDL-cholesteral was already very low: their average LDL-cholesterol was only 71mg (mean population level is 130mg). Perhaps these patients had no further “room” for improvement. There are other studies in the research pipeline which look at the effects of niacin on other patient populations, and I look forward to them.
*******************************************************************************************************************************************************
James D. Mickle, Jr. MD opens Santa Fe Office February, 2011
James D. Mickle, Jr., MD has opened a private practice, Cholesterol Studies and Treatment, dedicated to diagnosing, halting, and reversing vascular disease. Dr. Mickle is an internationally recognized expert on advanced techniques for diagnosing and treating artery disease, the cause of the number one and number three killers of adults in the United States: heart attack and stroke.
Dr. Mickle is a graduate of the Hershey Medical School in Pennsylvania, and was practicing family medicine in the Philadelphia area when he became increasingly puzzled by inconsistencies between the standard medical approach to high cholesterol numbers and the lives of some patients. “As my patients aged, I saw how many diseases stem from cholesterol problems, and I was intrigued by some mysteries—the ninety-year-old who has high cholesterol numbers but excellent health, or the forty-year-old with good numbers who suffers a heart attack. I delved into cholesterol research, and fine-tuned care of my patients.” In 2008 Dr. Mickle became board-certified as a Clinical Lipidologist. “That’s a new specialty—a big word for someone who specializes in artery disease caused by lipids--fats such as cholesterol and triglycerides.” Dr. Mickle currently serves on the Society of Atherosclerosis Imaging and Prevention’s Advisory Council for IMT (intima-media thickness) Ultrasound in Clinical Practice. This international group is formulating new recommendations for the use of carotid artery ultrasound in assessing the state of a patient’s vascular system.
Dr. Mickle believes that the standard diagnostic and treatment protocols are far behind the latest research. For instance, “the lab test that best predicts artery disease is not the familiar LDL (‘bad’) cholesterol test, but rather a tragically under-used test called ApoB. Another underused test is the carotid artery ultrasound, which enables us to visualize the arteries and determine whether or not there is disease, not just guess at the state of patients’ arteries from their lab tests.” He has found that natural supplements, as well as diet and lifestyle changes, can be crucial to artery health. He also believes that statins (prescription cholesterol-lowering medications) are over-prescribed to some patients whose arteries prove healthy, no matter what their basic lab tests say.
Dr. Mickle has opened a practice in Santa Fe for reasons both personal and professional. “Like so many people, I have long loved New Mexico for its natural beauty, diversity, and cultural richness. I have family here, and I think that this is a community that is health-conscious, and receptive to new ideas and natural approaches, while wanting world-class health care.”
James D. Mickle, Jr. MD, Santa Fe Cholesterol Expert,
Speaks to International Physicians and Researchers in Bethesda, Maryland
Santa Fe, NM, March 23, 2011 - James D. Mickle, Jr. MD, of Cholesterol Studies and Treatment in Santa Fe, will be a speaker at the Society for Atherosclerosis Imaging and Prevention Training Academy in Bethesda, Maryland, April 14-15, 2011. These training sessions for physicians and cardiac care specialists precede the annual meeting of the Society for Atherosclerosis Imaging and Prevention in Bethesda, April 15-17.
Dr. Mickle is an internationally recognized expert in the use of carotid artery ultrasound to diagnose the presence and progression of arterial disease caused by cholesterol buildup in the arteries. Dr. Mickle says, “Ultra-sound imaging of the carotid artery enables us to visualize the actual state of a patient’s arteries, and not just guess based on cholesterol numbers. Sometimes it reveals that a patient’s arteries are plaque-free and healthy, and suggests that, even in the face of abnormal lab tests, doctors might recommend natural treatments only—supplements, diet, and exercise. When a patient does have plaque in the arteries, imaging can help guide treatment. When we see halting or reversal of disease, we know that our treatment is working.”
Dr. Mickle currently serves on the Society of Atherosclerosis Imaging and Prevention’s Council for IMT (intima-media thickness) Ultrasound in Clinical Practice. This international group is formulating new recommendations for the use of carotid artery ultrasound in assessing the state of a patient’s vascular system.
Dr. Mickle explains, “I am one of a few full-time clinicians—doctors seeing patients every day--on that panel. Other members are distinguished researchers from around the world. I was invited to participate because I have been doing carotid artery ultrasound in my office for 11 years, and had a body of experience to share with research-oriented physicians and scientists.”
Dr. Mickle is a board-certified lipidologist (cholesterol specialist) and has recently opened Cholesterol Studies and Treatment in Santa Fe, where he employs carotid artery ultrasound and advanced lab tests to assess the state of a patient’s arteries.
Cholesterol Studies and Treatment is located at 4 Calle Medico, Suite C, Santa Fe, 87505.
Call 505-699-1172, or email us at [email protected]
