September 18, 2019 by John Fernandez
Lipid Program Fights Statin Intolerance, Aims for Heart Attack, Stroke Prevention
Most people understand the importance of managing high cholesterol and its crucial link to cardiovascular health. But for those patients who cannot control their raised blood fats, known as lipids, even after standard medical interventions, there is a new 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 one of every three U.S. adults have high levels of “low-density lipoprotein cholesterol” (LDL-C), considered the “bad” cholesterol, because it contributes to fatty plaque buildups and narrowing of the arteries. About 95 million, or 40 percent, 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 of heart disease and stroke. Others may have genetic factors or other lipid-related risk not seen in usual blood testing.
‘Optimal Prevention of Heart Attack
“The majority of the patients who are at risk for cardiovascular disease are well-managed by their primary care doctors and clinical cardiologists,” says Jonathan Fialkow, M.D., Deputy Medical Director Chief of Cardiology and a certified lipid specialist at Miami Cardiac & Vascular Institute. “Our lipid clinic expertise and infrastructure is meant to make an individualized assessment and treatment plan for eligible patients for optimal prevention of heart attack and stroke.”
The Lipid Program also provides assessments and tools for family members of at-risk patients 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
“This field is complex enough and large enough that it warrants a dedicated lipid program led by a certified lipidologist (Dr. Fialkow) and additional cardiologist with focus on prevention and metabolic disorders (Dr. Feldman), with the support from a nurse practitioner who also has additional training in lipid management and who’s been doing this for quite some,” says Ian Del Conde, M.D., associate medical 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 program also sees many patients who have a reason to be on statin drugs. For nearly 30 years, cholesterol-lowering medications, known as statins, have been available to reduce the risk of heart attacks in individuals who had suffered previous heart 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 at goal for optimal risk reduction
“For example, with a history of a heart attack, they need to be on a statins — regardless of their cholesterol level,” says Dr. Feldman. “They may need to be on statins, but they’ve tried it and they’re not tolerating it and they 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 as 20 percent of individuals with a clinical indication for statin therapy are unable to take a daily statin because of some degree of intolerance, according to a recent study. Moreover, 40 to 75 percent of patients discontinue their statin therapy within 1 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.