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Cardiac Care

Cholesterol. I want to talk about some of the new things that have become available to us. Baycol is an HMG co-A reductase inhibitor. Itís Cerivastatin. It does reduce cholesterol, both total cholesterol and LDL cholesterol, and with the recommended dosage it can probably reach that 20 -25% reduction that you heard was probably significant. It does require monitoring of the liver function tests like the other statins and like the other statins you have to be acute and chronically aware of the potential interactions with other medications. At this point in time, it probably does not have any apparent significant advantage over the other cardiac care, angina, chest pain, cholesterol, colesterol

The other statin that I wanted to briefly mention was Lipitor, or atorvastatin. This drug seems to have a very potent initial response, as far as lower total cholesterol, LDL and triglycerides. When you look at how this drug stacks up against the other statins, the lowest dose of this drug appears to reduce the LDL and cholesterol in an

The Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC VI). Over the years with the different JNC trials weíve seen the pendulum swing back and forth as far as whatís the first choice of medication for high blood pressure. And now we are back to where we were probably ten or 12 years ago as far as diuretics and beta-blockers. Now as I read through this last JNC recommendation, probably the most significant difference is that they are loosening up and liberalizing a little bit, with regard to the use of combination drugs. Several years ago we used to have what was called the "step" therapy approach. You pay your money, you

Then there is also the consideration of co-morbid conditions. There is a category of compelling indications in this last series of recommendations. For example, diabetics with proteinuria. Thereís a strong indication for using ACE

Now in the last year, year or two, we have seen one new beta-blocker enter the arena and that is Coreg, curvediol. Itís a non-selective beta-blocker and itís indicated for both hypertension and congestive heart failure. This is pretty remarkable when you think about five or six years ago we all stood back and said, "Um, beta-blocker? Congestive

With regard to smoking cessation, you may or may not have heard of the drug Zyban, which is basically Wellbutrin, an antidepressant repackaged. This is given in a dose of 150 mg twice a day. It seems to help with the curbing of the urge for the smokers. In one respect itís better than using nicotine substitutes in that in case your patients exhibit their

Thrombolytic therapy in this city is pretty unusual. We have a very aggressive and competent force of cardiologists here in this town and basically from door to Cath Lab can be an hour. And I think that is the goal here. For those of our colleagues that practice in more remote areas, thrombolytics still play an important role in how they manage their patients and need to be utilized because a potentially life-saving benefit of these drugs is 

With regard to long-term management, you heard a lot this morning and I donít want to be redundant, however I do want to reinforce the thoughts about lifestyle. I think that a very pertinent point was mentioned and I want to reinforce that point, and thatís; when all this technology is swirling around the patient, as far as what has happened