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Dx Cholesterol Lowering Medical Theraphy:

For most individuals, there is no reduction in mortality by restricting therapy to the simplest, safest, cheapest atorvastatin (Lipitor), thereby eliminating Crestor, Vytorin and other drug therapies. Furthermore, Rose in 1991 established the criteria that statins would not be prescribed to individuals without extensive validation of plaque formation in the coronary arteries. Validation is performed as an outpatient, Computerized Tomography Coronary Artery Calcium Score (CACS). Calcium scores of less than 100 without concurrent diabetes, heart disease, strokes. etc. are indications to hold off statin use.

Statin users are reminded to replenish the supplement coenzyme Q-10 which is diminished by statins.

Overview Cholesterol

The Merck Manual Home Edition states:
"Cholesterol and triglycerides are important fats (lipids) in the blood. Cholesterol is an essential component of cell membranes, brain and nerve cells, and bile, which helps the body absorb fats and fat-soluble vitamins. The body uses cholesterol to make vitamin D and various hormones, such as estrogen, testosterone, and cortisol. The body can produce all the cholesterol that it needs, but it also obtains cholesterol from food. Triglycerides, which are contained in fat cells, can be broken down, then used to provide energy for the body's metabolic processes, including growth. Triglycerides are produced in the intestine and liver from smaller fats called fatty acids. Some types of fatty acids are made by the body, but others must be obtained from food (see see Fats).
*Fats, such as cholesterol and triglycerides, cannot circulate freely in the blood, because blood is mostly water. To be able to circulate in blood, cholesterol and triglycerides are packaged with proteins and other substances to form particles called lipoproteins.
*There are different types of lipoproteins. Each type has a different purpose and is broken down and excreted in a slightly different way. Lipoproteins include chylomicrons, very low density lipoproteins (VLDL), low-density lipoproteins (LDL), and high-density lipoproteins (HDL). Cholesterol transported by LDL is called LDL cholesterol, and cholesterol transported by HDL is called HDL cholesterol.
*The body can regulate lipoprotein levels (and therefore lipid levels) by increasing or decreasing the production rate of lipoproteins. The body can also regulate how quickly lipoproteins enter and are removed from the bloodstream.
*Levels of cholesterol and triglycerides vary considerably from day to day. From one measurement to the next, cholesterol levels can vary by about 10%, and triglyceride levels can vary by up to 25%.
*Lipid levels may become abnormal because of changes that occur with aging, various disorders (including some hereditary ones), use of certain drugs, or lifestyle (such as consuming a high-fat diet, being physically inactive, or being overweight).

*[Editor] In the Journal of the American Medical Association, February 5, 2014 appear the new guidelines of the American College of Cardiology and the American Heart Association REVERSING ALL THE PREVIOUS OVER-REACH of the MEDICAL INFORMATION. The new conclusion is just that "cheap, inexpensive, extensively studied statins are clearly identified as the first-line drug therapy; and treatment targets are abandoned."

*[Editor] Every man over the age of 45 and woman over the age of 60 should have a Coronary Artery Calcium Score (C.A.C.S.). This is a 30-second rapid C.T. scan of the chest that documents the presence, size, and volume of calcification. If he/she has calcification C.A.C.S. strongly predicted future major adverse cardiac events." On the positive side, having a score of zero or even a C.A.C.S. score less than 100, says the John Hopkin's group, "will find that individual is at virtually no risk "of having a heart attack" and "for older individuals without calcium in their arteries, it means they do not need routinely prescribed cholesterol lowering medications or aspirin because they are at a lower risk of a heart attack."

Medications Used in the Treatment:
1. Statins: Zocor®/simvastatin, Lipitor®/atorvastatin, Pravachol®/pravastatin, Crestor®/rosuvastatin, Mevacor®/lovastatin, Altoprev®/lovastatin er, Livalo®/pitavastatin, Lescol®/fluvastatin /tr>
2. Fibrates: Lofibra®/fenofibrate, Tricor® Liofen®/fenofibrate, Lopid®/gemifibrozil, Antara®/fenofibrate micronized, Trilipix® Fibricor®/ fenofibric acid, Triglide®/ fenofibrate, Fenoglide®/fenofibrate
3. Cholesterol Absorption Inhibitors: Zetia®/ezetimibe
4. Nicotinic Acids: Niaspan®ER/niacin, Niacor®/niacin
5. Omega-3 Fatty Acids: Lovaza®/omega-3 fatty acids, Vascepa®/icosapent ethyl
6. Cholesterol Absorption Inhibitor/Statin Combination: Vytorin®/ezetimibe-simvastatin
7. Bile Acid Sequestrants: Welchol®/colesevelam, cholestryramine, Colestid®/colestipol, Prevalite/ cholestyramine
8. ApoB Inhibitor: Kynamro®
9. MTP Inhibitors: Juxtapid®
10. Thyroid Replacement: Levothyroxine, Natur-throid, Armour thyroid

*[Editor]NEW CONCLUSIONS: (1) Diet, (2) bio-identical hormones (especially thyroid, vitamin D3 and testosterone), (3) supplements such as niacin, omega-3, and optionally Red Yeast Rice or guar gum, (4) Coronary Artery Calcium Scoring of men at 50 and women at 65 (earlier with chronic disease), and then a statin with additional Co-enzyme Q10. There is no need for A Billion People Taking Statins

*[Editor] With the ability to measure, prior to your doctor visit, 12 bio-identical hormones, vitamins, minerals, blood count and selective markers for less than four-hundred ($400) dollars, it seems illogical not to correct these imbalances first, and then, later, to measure the lipid panel. Every one of the bio-identical hormones, when normalized, can have a positive effect on the cholesterol, triglycerides and LDL/HDL ratios.

*A study of
depressed individuals showed 20% had hyothyroidism and a mean cholesterol 150% of normal.

*Do You Need Any of These Medications when over-the-counter substitutes are 10 times cheaper?
*See Over-the-counter-Remedies and Alternative Cholesterol Treatments/ Information Page

1. Statins: If the Coronary Artery Calcium Score is less than 100, statins are not necessary. Statin therapy has never been investigated in men or women over age 85, making use in this age group an unknown risk.
  All statins lower Co-enzyme Q10 (Ubiquinol). Merck tried to market a combination statin-CoQ10 and the FDA rejected the medication. The Editor recommends ubiquinol to all his patients on statins. It is inexpensive, CoQ levels drop with aging, and it may counteract, somewhat, the HMG-CoA effects of the statins.
2. Fibrates: In a large national 5-year study of clofibrate, beta-blockers and/or diuretics, more died on treatment than on nothing! "Multiple logistic regression analysis of treatments in the intervention group did not explain the 15-year excess cardiac mortality."
  Furthermore, guar gum, which is found in most grocery stores, can be used to make cakes and cookies, was found to significantly reduce trans-fatty acids. The side-effect of too much guar gum may be constipation.
3. Cholesterol Absorption Inhibitors, alone or in combination with a statin (Vytorin®) are probably unnecessary. Medical publications suggest that "combinations of lipid-lowering agents (Crestor®/rosuvastatin alone or a statin and Vytorin®/ezetimbe)do not improve clinical outcomes more than high-dose statin monotherapy." This implies that Lipitor®/atorvastatin which is today free at Meijer's or Pravachol®/pravastatin at $11.11 per 100 tablets is as effective and significantly less costly.
4. Nicotinic Acid has been shown to increase HDL (good) cholestrerol. Inexpensive niacin's side-effect of flushing is blocked by an 81mg aspirin making prescription medication usually unnecessary.
5. Omega-3: Lovaza® is just omega-3 fish oil. The prescription product is 10-times more expensive than Biotics® Bio-Omega. There is no significant difference in purity or absorption.
6. Bile Acids Sequestrants: For $60, a person can take two 1-gm tablets daily. Combining daily, colestid 2 grams, Biotics® Bio-omega 3 grams and Biotics® nicotinic acid (250mg increased gradually to 1500mg per day) is the most natural treatment of the symptom of elevated cholesterol. Follow your own results at 6-month intervals with your self-ordered Lipid Profile for less than $45 (forty five dollars).

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