HERBAL APPROACHES TO HYPERLIPIDEMIA. Patrick M. Fratellone, MD, RH (AHG), FIM, FACC New York, New York

Transcription

1 HERBAL APPROACHES TO HYPERLIPIDEMIA Patrick M. Fratellone, MD, RH (AHG), FIM, FACC New York, New York Patrick M. Fratellone, MD, RH (AHG) FIM, FACC November, 2013

2 CASE PRESENTATIONS

3 CASE #1 46 YEAR OLD WHITE MALE WITH A HISTORY OF HTN AND HYPERLIPIDEMIA. PREVIOUS MEDICATIONS INCLUDED: PREVIOUS MEDICATIONS: 1. Avapro 300 mg PO qd BP: 160/92 2. Diovan 80/12.5 mg PO bid BP: 140/90 Labs: Cholesterol 238 ; TG 140; LDL 160; HDL 50 Trial of Benecar 20mg PO qd started: BP measurements: / / /78 Add diuretic: Benecar 20/12.5 qd; BP / 60-70

4 CASE #2 53 YEAR OLD WHITE MALE PRESENTS WITH A PAST MEDICAL HISTORY OF 2 MI, 2 STENTS OF THE RCA IN 1998 AND 1999 AND A THIRD STENT IN Current medications: 1. Toprol XL: 100 mg PO qd 4. ASA 81mg PO qd 2. Diovan/Hct 80/12.5 mg PO qd 5. Imdur 30 mg PO qd 3. Plavix 75mg PO qd 6. Lipitor 20mg PO qd BP 140/80-90; Labs: Cholesterol 137; TG 210; HDL 32 ; LDL 63 CRP-HS 4.1; Fibrinogen 334; Homocysteine 8.55; microalbumin 4.0 (NL < 2.9 ) Results: Mycoplasma fermentans Treatment Plan: Benecar 20/12.5 mg PO qd Retest microalbumin in 6 weeks

5 CASE #3 73 YEAR OLD BLACK FEMALE WITH A PAST MEDICAL HISTORY OF HTN X 20YEARS. BP RANGES FROM 130/90 TO 200/120. SHE HAS DYSPNEA ON EXERTION. DENIES CHEST PAIN, AND SYNCOPE; HAS NEW EDEMA PRESENT AND PALPITATIONS Current Medication: Labs: 1. Calan SR 180 mg PO qd x 15 years BP: 160 / Hyzaar 100/25 mg PO qd Cholesterol 140; TG 91; HDL 61; LDL 68; Homocysteine 12.1; 18; CRP HS 4.6 ; Labs: microalbumin: 6.0 ; Microalb/creat ratio:.050 (NL <.020) Plan: 1. Stress thallium: NL 2. Holter : NSR with PAF 3. Change Calan to Tiazac 180mg PO qd 4. Change Hyzaar to Benecar 20/12.5 qd 5. BP on new regimen: 140/90

6 CASE #4 60 YEAR OLD WHITE MALE WITH A HISTORY OF HYPERTENSION, CAD, HYPERLIPIDEMIA,AND DEPRESSION ; PATIENT REFUSED INVASIVE PROCEDURE AFTER ABNORMAL STRESS TEST. PATIENT ELECTED TO HAVE EECP. POST STRESS EECP: NO ISCHEMIA PRESENT Medications: 1. Nadolol 80 mg PO qd 3. Welchol 625mg PO -6/day 2. Norvasc 2.5 mg PO qd 4. ASA 81 mg PO qd Vitals: 140/ 90 -HR 55- Weight 231 Labs: microalbumin/creat =.040 ( NL <.020 ) Cholesterol 214; LDL 139; TG 112; HDL 53 Treatment Plan: 1. Discontinue welchol change to lipitor 20 mg PO qd 2. Discontinue Norvasc as edema; start micardis/hct 80/12.5 mg PO qd 3. BP no change 140 / 90 after 1 month 4. Discontinue micardis; start : Benecar HCt 40/12.5 mg PO qd 5. BP 130/80 after 1 month

7 HERBAL APPROACHES TO HYPERLIPIDEMIA Total Cholesterol <200 Triglycerides <150 HDL High Density Lipoprotein LDL Male >40 Female > 50 Low Density Lipoprotein 1. < < <70

8 CHOLESTEROL Made in the liver Parent molecule for other hormones Statins: Inhibit HMG co-reductase

9 LIPID PARTICLES Confirm type of particle size both HDL and LDL This is done by Berkley Heart Lab and other labs Quest Lab: VAP, NMR Bioreference: ACT

10 TWO TYPES OF HDL (GOOD CHOLESTEROL) Good, with a good particle Good particles are large, fluffy (buoyant) Protection for the heart HDL-II Good, with a bad particle Bad particles are small, dense Non-protection for the heart HDL III

11 TWO TYPES OF LHDL (BAD CHOLESTEROL) Bad, with a good particle Good particles are large, fluffy Not associated with heart disease This is Pattern A Bad, with a Bad particle Good particles are large, fluffy Associated with heart disease This is Pattern B

12 TREATMENT Before treatment Determine particle size of both HDL and LDL More important to treat LDL with bad particles Treatment Dietary lifestyle changes Less meat,, dairy, and inflammatory foods decrease LDL High alkaline foods Decrease in refined carbohydrates increase HDL Increase in Omega 3 (Cold water fish) Exercise lifestyle changes Increase HDL (Good cholesterol)

13 TREATMENT (CONTINUED) Statin Drugs Conventional treatment Supporting evidence of benefits Side effects Liver Muscle Depression Memory Loss Sexual Drive Deplete Coenzyme Q10 Levels

14 TREATMENT (CONTINUED) Herbal Treatment Red Rice Yeast (Monecus purpurus) Green Tea (Camellia sinensis) Garlic (Allium sativum) B Sitosterol (Plant sterols)

15 RED RICE YEAST (MONECUS PURPURUS)

16 GREEN TEA (CAMELLIA SINENSIS)

17 GARLIC (ALLIUM SATIVUM)

18 B SITOSTEROL (PLANT STEROLS)

19 CASE 1 43 year old white male with a family history of cardiovascular disease presents to your office. He is anxious as his father had his first heart attack at age 43. He has had a corporate physical revealing a blood pressure of 126/74, heart rate 72, height 5 8, weight 198. He has no complaints. Physical examination: Unremarkable Takes no medications DISCUSSION: 1. What else would you like to know about this patient? 2. What blood tests would you like to see? 3. Do you need an electrocardiogram?

20 CASE 1 1. ECG: Normal 2. LABS: Chemistry normal: fasting glucose LIPIDS: 1. Total cholesterol HDL TG LDL 120

21 CASE 2 72 year old post menopausal female with a known history of heart disease wants a different approach to her health. She feels she takes too many medications. Her medications include: Cozaar (ARB) 100mg PO qd Lipitor (statin) 40 mg PO qd HCTZ (diuretic) 25 mg PO qd Actonel does not recall dose Metformin 500 mg PO b.i.d. Namendia 10 mg PO qd Aricept 5 mg PO q.d. Vitals: 130/72 HR: 74 Height 5 6 Weight: 147 Physical Exam: Mildly obese; Systolic murmur 2/6 Apex and Axilla OTHERWISE NORMAL EXAM

22 CASE 2 1. Cholesterol LDL HDL TG FBS Potassium NL CBC Otherwise other labs normal DISCUSSION:

23 CASE 3 64 year old male with a history of hyperlipidemia on medications. Patients wants to stop his statin drug. He feels this is a family-type of cholesterol trait. He exercises regularly. His diet is clearly not his problem. Medications: Crestor 5.0 mg PO qd Labs: Cholesterol 170 TG: 84 LDL: 110 HDL: 46 DISCUSSION: 1. Would you stop the statin as he asks? 2. What blood tests would help you make your decision?

24 SUPPLEMENTS 1. Vitamin E 2. B Vitamins 3. Carotenoids 4. Flavonoids 5. Magnesium 6. Coenzyme Q10 7. L-Carnitine 8. Omega 3 Fatty Acids 9. L-Arginine 10. L-Taurine

25 IT S BEEN A PLEASURE THANK YOU!