What Now for Vytorin? In? or Out?

Not too long ago Vytorin which is a combination of simvastatin and ezitimibe was lambasted after a negative study with the ENHANCE trial showing no proof of plaque regression despite a significant reduction in LDLc. It may have been a faulty study for which I think the study investigator maybe pushing this drug too much that their baseline thickness of the carotid intima maybe considered normal to start with......how can you expect further improvement when your baseline is already almost normal? It would have been better if they looked at a longer term trial comparing reduction of LDLc with inhibition of plaque progression rather than regression. I have always deep inside me believe that this was a flawed trial right from the beginning and I have continued to use the drug most importantly to my severely hyperlipidemic patients waiting for more proofs.

In medicine, our dictum is to do no harm. We have not seen harm done on patients with vytorin...that one study showed us that it " may " not be doing what it is supposed to do. We also need to mention that Simvastatin which is the statin component of vytorin has tons of proofs for the benefit our patients get from the drug hence, it just does not make sense why additional reduction of LDLc could hurt our patients?

Recently, the SANDS trial ( Stop Atherosclerosis in Native Diabetes Study) published in the Journal of the American College of Cardiology December 2008, a 36-month study, looking at regression in carotid intima in the diabetics showed that aggressive LDL reduction with ezetimibe + a statin or statin alone noted in patients with Type 2 diabetes mellitus was associated with a similar regression in carotid intima thickness. This is surely a a positive news and a welcome respite for this drug and a good reassurance not only to the medical practitioners but patients alike who got confused with earlier study results.

State of the Art in Cebu!

Finally the wait is over, our patients can now avail of the state of the art technology right at the heart of Cebu City. As Director of the Cebu Doctors' University Hospital Cardiac Catheterization Laboratory, I am proud to introduce our new GE Innova 2100 Flat Panel cardiac catheterization machine. This state of the art laboratory being made available to patients in the Visayas and Mindanao.

Cebu Doctors' University Cardiovascular Center is considered to be the most active cardiovascular center in Cebu City. This new laboratory would embolden our patients to take the right choice for their cardiovascular needs because they know we don't take their health for granted investing in high end machine to provide accurate and reliable result. We do various procedure including left and right heart catheterization, pacemaker implantation, hemodynamic studies, coronary angiography as well as percutaneous coronary intervention including surgical coronary bypass procedures, valvular replacements and many more.....

For more information, comments, or inquiries, please email me at: EdgarTan62@yahoo.com.

PCI vs CABG: Is it really an option?

In the real world, coronary disease remains to be the most prevalent cause of cardiovascular mortality and morbidity. The treatment options have continued to evolve especially with the rapid advances in percutaneous intervention blurring the difference between which form of therapy is better for a particular patient. The evolution of drug-eluting stent blurs the once mighty benefit of surgical bypass to the issue of lower incidence of repeated intervention rather than the hard end points of myocardial infarction and death.

PCI saves lives in acute coronary syndrome, these are patients brought to the emergency room with acute chest pains due to ischemia.

PCI has never been shown by various studies to be superior to optimal medical therapy in preventing MI in the stable patient. PCI in the setting of stable patient is best reserved for those that remain symptomatic inspite of maximal medical therapy.

Diabetics are a special group of patients at risk for repeated intervention if percutatneous intervention is employed hence, diabetics as a rule are best served with coronary artery bypass surgery rather than PCI. There are always exeption to the rule hence, an office discussion with your physician maybe warranted in this regard.

I will be giving a talk on revascularization options for patients with coronary artery disease during the Philippine Heart Association Post Graduate course on February 8, 2008 at the Waterfront Hotel, Cebu City. Feel free to email me at EdgarTan62@yahoo.com for any quesitons.