Lipid Program Fights Statin Intolerance, Aims for Heart Attack, Stroke Prevention

Most peopleunderstand the importance of managing high cholesterol and its crucial link tocardiovascular health. But for those patients who cannot control their raised bloodfats, known as lipids, even after standard medical interventions, there is anew option. 

The Lipid Management Program at Miami Cardiac & Vascular Institute is part of a growing trend nationally to improve oversight and treatment of individuals who have not responded to initial therapies to combat their dyslipidemia, the term referring to an abnormal amount of lipids (triglycerides, cholesterol and/or fat phospholipids) in the blood.

Nearly oneof every three U.S. adults have high levels of “low-density lipoproteincholesterol” (LDL-C), considered the “bad” cholesterol, because it contributesto fatty plaque buildups and narrowing of the arteries. About 95 million, or 40percent, of U.S. adults have total cholesterol of 200 mg/dL or higher. LDL-C(or bad cholesterol) levels of 100 mg/dL or lower are linked to lower rates ofheart disease and stroke. Others may have genetic factors or otherlipid-related risk not seen in usual blood testing.

‘Optimal Prevention of Heart Attackand Stroke’
“The majorityof the patients who are at risk for cardiovascular disease are well-managed bytheir primary care doctors and clinical cardiologists,” says  Jonathan Fialkow, M.D.,Deputy Medical Director Chief of Cardiology and a certified lipid specialistat Miami Cardiac& Vascular Institute. “Our lipid clinic expertise and infrastructure ismeant to make an individualized assessment and treatment plan for eligiblepatients for optimal prevention of heart attack and stroke.”

The LipidProgram also provides assessments and tools for family members of at-riskpatients to be identified for possible early prevention strategies, he adds.

The program at Miami Cardiac & Vascular Institute targets patients who don’t have the ability to tolerate standard therapies or are unable to get to risk-reduction goal with traditional medications or doses, says Dr. Fialkow, who manages the MCVI with Theodore Feldman, M.D., medical director of prevention and community health at Miami Cardiac & Vascular Institute The team includes Lisa Klein Davis, PA-C, certified lipid specialist and Jennifer Miles-Nguyen, clinical pharmacist

“Thisfield is complex enough and large enough that it warrants a dedicated lipidprogram led by a certified lipidologist (Dr. Fialkow) and additional cardiologistwith focus on prevention and metabolic disorders (Dr. Feldman), with thesupport from a nurse practitioner who also has additional training in lipidmanagement and who’s been doing this for quite some,” says Ian Del Conde, M.D., associatemedical director of cardiology at the Institute.

Patient Candidates for Lipid Program
What type of patients take part in the Lipid Program? “They can be patients with high cholesterol, and they fall into many different subgroups,” explains Dr. Del Conde. “For example, they can be patients with familial hyperlipidemia — they are just born with genetically determined, very high levels of cholesterol.” Many may not have elevated cholesterol, but have aggressive cardiovascular disease and are at high risk through other conditions that the Lipid Clinic team can recognize and treat.

The programalso sees many patients who have a reason to be on statin drugs. For nearly 30years, cholesterol-lowering medications, known as statins, have been availableto reduce the risk of heart attacks in individuals who had suffered previousheart attacks and who have high levels of LDL cholesterol. Despite this,studies show over 60% of high risk individuals are not on statins or not atgoal for optimal risk reduction

“Forexample, with a history of a heart attack, they need to be on a statins —regardless of their cholesterol level,” says Dr. Feldman. “They mayneed to be on statins, but they’ve tried it and they’re not tolerating it andthey may develop some side effects.”

“Some may benefit from goals that are more aggressive than generally targeted by medical community,” adds Dr. Fialkow. The Lipid Management team works with these patients and has shown great success in getting people treated with the appropriate results to decrease their cardiovascular risk

As many as20 percent of individuals with a clinical indication for statin therapy areunable to take a daily statin because of some degree of intolerance, accordingto a recent study.Moreover, 40 to 75 percent of patients discontinue their statin therapy within1 to 2 years after initiation.

“As part of the Lipid Program, we can understand their intolerance and see if we can navigate around it by using different statins, looking at the different pharmacological properties of each of the statin drugs and which ones are less likely to cause side effects,” says Dr. Fialkow.

For more information on the Lipid Program, call 786-204-4499.