"Liquid Drano" for arteries

Sharon Hope said:

New drug heralded as a miracle drug for opening clogged arteries.

I think this is a great step forward, but I heard on NPR this mornining
that it is considered a drug because it was genetically engineered.
Pharmaceutical companies can patent genetically engineered drugs, but
cannot patent plain old HDL. 'HDL' donors, like blood donors - where could
it lead us?

I havn't been able to access www.pubmed.gov this morning for some reason,
but this study is intruiging and illustrates that atherosclerosis can
indeed be reversed with proper management.

Quoted message said:

Essentially, they ADDED cholesterol, the "good" HDL, to patients, and
their
arteriosclerosis blockages quickly melted away.

Note, though, folks. Apparently just giving people HDL is not patentable,
so
no drug company would look into it because there would be no profits.
This
is the only drug, except one by Pfizer, that has a patentable version of
HDL.

Beware getting too enthused about this at first, though. Suddenly the
Lipitor cheerleaders are using the same unprofessional medical
superlatives
about this drug as, "Astonishing", "Amazing", and "Holy Grail". These are
exactly the same cast of characters who have made it their business to be
sure that no honest studies that show negative effects of Lipitor or the
other statins get published, or, if they slip through, they are instantly
attacked and prefaced by journal editorials as 'flawed.' YMMV

http://www.nytimes.com/2003/11/04/health/04CND-
CHOL.html?ex=1068613200&en=5509e0dc62883210&ei=5062&partner=GOOGLE>
Study Finds New Drug Acts Quickly on Clogged Arteries

Test Achieves Cholesterol Breakthrough
http://www.foxnews.com/story/0,2933,102243,00.html

New treatment works like 'liquid Drano for arteries'
Experiment injected 'good' cholesterol into heart patients
http://www.cnn.com/2003/HEALTH/11/04/cholesterol.breakthrough.ap/index.html

http://story.news.yahoo.com/news?tmpl=story&cid=571&ncid=751&e=1&u=/nm/20031105/hl_nm/health_esperion_dc
Drug Appears to Unclog Arteries - Study

The previous study on this drug is reported in Pub Med at:

Intramural delivery of recombinant apolipoprotein A-IMilano/phospholipid
complex (ETC-216) inhibits in-stent stenosis in porcine coronary
arteries.
Circulation. 2003 May 27;107(20):2551-4. Epub 2003 May 12.
PMID: 12742990 Kaul S, Rukshin V, Santos R, Azarbal B, Bisgaier CL,
Johansson J, Tsang VT, Chyu KY, Cercek B, Mirocha J, Shah PK.
Vascular Physiology and Thrombosis Research Laboratory of the
Atherosclerosis Research Center, Cedars-Sinai Medical Center, Los
Angeles,
Calif 90048, USA. [email hidden]

--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice

"Patrick Blanchard, M.D." <[email hidden]> wrote in part:

Quoted message said:

I think this is a great step forward, but I heard on NPR this mornining
that it is considered a drug because it was genetically engineered.
Pharmaceutical companies can patent genetically engineered drugs, but
cannot patent plain old HDL. 'HDL' donors, like blood donors - where could
it lead us?

I'd been wondering when there would be a report of a clinical trial using HDL.

The subject study is very interesting and probably does confirm that something
about HDL in some people can reverse atherosclerosis. But it used a variant of
HDL designed to capture the "fluffiness" we keep reading about. So it's still
not clear if less fluffy HDL would do the trick, I guess.

OTOH, one increases HDL currently mainly with weight loss, exercise, alcohol,
fish oil, and carbohydrate restriction (at least for many of us). Add niacin
and statins (somewhat) if drugs are considered.

And, i don't know how true this is, but it looks like the ratio of
triglyceride to HDL correlates with "fluffiness" of LDL and HDL(Type "A" vs
Type "B"😉. Some studies suggest that, anyway.

So reducing TG may be as important as raising HDL.

In my own case, following the AHA diet gives me a TG/HDL of between about 4.1
and 7.1. Low carbing (not exactly Atkins, but substituting lots of mostly
monosaturates and fish oil for high-glycemic carb calories) dropped the TG/HDL
to 1.1. I also have records that show the ratio at the same BMI (22), but
low-fat diet (7.1) and lower-carb, higher fat diet (1.1).

I have CAD, based on an EB CAT scan. Hopefully, it is regressing based on my
musings above...
--
Jim Chinnis Warrenton, Virginia, USA

On Wed, 05 Nov 2003 15:15:56 GMT, Jim Chinnis <[email hidden]>

Quoted message said:

"Patrick Blanchard, M.D." <[email hidden]> wrote in part:

Quoted message said:

I think this is a great step forward, but I heard on NPR this mornining
that it is considered a drug because it was genetically engineered.
Pharmaceutical companies can patent genetically engineered drugs, but
cannot patent plain old HDL. 'HDL' donors, like blood donors - where
could it lead us?

I'd been wondering when there would be a report of a clinical trial using
HDL.

The subject study is very interesting and probably does confirm that
something
about HDL in some people can reverse atherosclerosis. But it used a
variant of
HDL designed to capture the "fluffiness" we keep reading about. So it's
still
not clear if less fluffy HDL would do the trick, I guess.

OTOH, one increases HDL currently mainly with weight loss, exercise,
alcohol,
fish oil, and carbohydrate restriction (at least for many of us). Add
niacin
and statins (somewhat) if drugs are considered.

And, i don't know how true this is, but it looks like the ratio of
triglyceride to HDL correlates with "fluffiness" of LDL and HDL(Type "A"
vs
Type "B"😉. Some studies suggest that, anyway.

So reducing TG may be as important as raising HDL.

In my own case, following the AHA diet gives me a TG/HDL of between about
4.1
and 7.1. Low carbing (not exactly Atkins, but substituting lots of mostly
monosaturates and fish oil for high-glycemic carb calories) dropped the
TG/HDL
to 1.1. I also have records that show the ratio at the same BMI (22), but
low-fat diet (7.1) and lower-carb, higher fat diet (1.1).

I have CAD, based on an EB CAT scan. Hopefully, it is regressing based on
my
musings above...
--
Jim Chinnis Warrenton, Virginia, USA

Jim, I am quite curious about your story with EBCT. Can you share it?

--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice

"Patrick Blanchard, M.D." <[email hidden]> wrote in part:

Quoted message said:

Jim, I am quite curious about your story with EBCT. Can you share it?

Not much to share: Age 59 now. had EBCT scan of c arteries prescribed by
internist two years ago due to extreme family history of CAD and my low HDL,
high TG pattern. Result showed left main, LAD, and RCA affected, with 16
lesions total. Agatston calcium score = 215.92; calcium volume score = 171.63.
This put me in the 70th percentile of "asymptomatic men my age with positive
scores." Followup thallium stress test was normal. Placed on 20mg pravastatin.
Since the scan, I have lost 32 lb (off over a year now) mostly from the diet I
described.
--
Jim Chinnis Warrenton, Virginia, USA

On Wed, 05 Nov 2003 16:12:34 GMT, Jim Chinnis <[email hidden]>

Quoted message said:

"Patrick Blanchard, M.D." <[email hidden]> wrote in part:

Quoted message said:

Jim, I am quite curious about your story with EBCT. Can you share it?

Not much to share: Age 59 now. had EBCT scan of c arteries prescribed by
internist two years ago due to extreme family history of CAD and my low
HDL,
high TG pattern. Result showed left main, LAD, and RCA affected, with 16
lesions total. Agatston calcium score = 215.92; calcium volume score =
171.63.
This put me in the 70th percentile of "asymptomatic men my age with
positive
scores." Followup thallium stress test was normal. Placed on 20mg
pravastatin.
Since the scan, I have lost 32 lb (off over a year now) mostly from the
diet I
described.
--
Jim Chinnis Warrenton, Virginia, USA

You're doing a great job! Will you tell me your opinion about the changing
criteria for risk factor management (cholesterol profiles, blood pressure,
weight, ...etc)?

--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice

"Patrick Blanchard, M.D." <[email hidden]> wrote in part:

Quoted message said:

On Wed, 05 Nov 2003 16:12:34 GMT, Jim Chinnis <[email hidden]>

Quoted message said:

"Patrick Blanchard, M.D." <[email hidden]> wrote in part:

Quoted message said:

Jim, I am quite curious about your story with EBCT. Can you share it?

Not much to share: Age 59 now. had EBCT scan of c arteries prescribed by
internist two years ago due to extreme family history of CAD and my low
HDL,
high TG pattern. Result showed left main, LAD, and RCA affected, with 16
lesions total. Agatston calcium score = 215.92; calcium volume score =
171.63.
This put me in the 70th percentile of "asymptomatic men my age with
positive
scores." Followup thallium stress test was normal. Placed on 20mg
pravastatin.
Since the scan, I have lost 32 lb (off over a year now) mostly from the
diet I
described.

Quoted message said:

You're doing a great job! Will you tell me your opinion about the changing
criteria for risk factor management (cholesterol profiles, blood pressure,
weight, ...etc)?

I have plenty of opinions, but I'm not an expert in cardiology by any stretch
of the imagination. I'm a scientist, though, and I consult on interpretation
of data, including medical and pharmaceutical testing, so I do read the
literature when I can.

What I am mostly struck by is how slow the standard-setters (such as the AHA)
seem to be to revise both what to assess and what to shoot for. The
preoccupation with very low dietary fat, then saturated fat (with a huge
number of servings a day of starch thanks to the US food pyramid!) is only now
starting to abate despite decades of evidence that this was counterproductive.

But I'll stop there. I'm happy to set my own criteria for risk management, but
I'm not qualified to do a wide-ranging critique of the "establishment's" work.
--
Jim Chinnis Warrenton, Virginia, USA

On Wed, 05 Nov 2003 18:25:21 GMT, Jim Chinnis <[email hidden]>

Quoted message said:

"Patrick Blanchard, M.D." <[email hidden]> wrote in part:

Quoted message said:

Jim Chinnis said:

"Patrick Blanchard, M.D." <[email hidden]> wrote in part:

> Jim, I am quite curious about your story with EBCT. Can you share it?

Not much to share: Age 59 now. had EBCT scan of c arteries prescribed
by
internist two years ago due to extreme family history of CAD and my low
HDL,
high TG pattern. Result showed left main, LAD, and RCA affected, with
16
lesions total. Agatston calcium score = 215.92; calcium volume score =
171.63.
This put me in the 70th percentile of "asymptomatic men my age with
positive
scores." Followup thallium stress test was normal. Placed on 20mg
pravastatin.
Since the scan, I have lost 32 lb (off over a year now) mostly from the
diet I
described.

Quoted message said:

You're doing a great job! Will you tell me your opinion about the
changing criteria for risk factor management (cholesterol profiles,
blood pressure, weight, ...etc)?

I have plenty of opinions, but I'm not an expert in cardiology by any
stretch
of the imagination. I'm a scientist, though, and I consult on
interpretation
of data, including medical and pharmaceutical testing, so I do read the
literature when I can.

What I am mostly struck by is how slow the standard-setters (such as the
AHA)
seem to be to revise both what to assess and what to shoot for. The
preoccupation with very low dietary fat, then saturated fat (with a huge
number of servings a day of starch thanks to the US food pyramid!) is
only now
starting to abate despite decades of evidence that this was
counterproductive.

But I'll stop there. I'm happy to set my own criteria for risk
management, but
I'm not qualified to do a wide-ranging critique of the "establishment's"
work.
--
Jim Chinnis Warrenton, Virginia, USA

Thanks Jim. Indeed, it is troublesome to see 'the' criteria shift like
sand.

--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice

Niaspan, available now, raises HDL without as much flushing of niacin.
Here's their "disease regression" study with 39% sucess rate:
http://www.niaspan.com/templates/hcp.asp?class=2&page=2

"Patrick Blanchard, M.D." <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Sharon Hope said:

New drug heralded as a miracle drug for opening clogged arteries.

I think this is a great step forward, but I heard on NPR this mornining
that it is considered a drug because it was genetically engineered.
Pharmaceutical companies can patent genetically engineered drugs, but
cannot patent plain old HDL. 'HDL' donors, like blood donors - where could
it lead us?

I havn't been able to access www.pubmed.gov this morning for some reason,
but this study is intruiging and illustrates that atherosclerosis can
indeed be reversed with proper management.

Quoted message said:

Essentially, they ADDED cholesterol, the "good" HDL, to patients, and
their
arteriosclerosis blockages quickly melted away.

Note, though, folks. Apparently just giving people HDL is not patentable,
so
no drug company would look into it because there would be no profits.
This
is the only drug, except one by Pfizer, that has a patentable version of
HDL.

Beware getting too enthused about this at first, though. Suddenly the
Lipitor cheerleaders are using the same unprofessional medical
superlatives
about this drug as, "Astonishing", "Amazing", and "Holy Grail". These are
exactly the same cast of characters who have made it their business to be
sure that no honest studies that show negative effects of Lipitor or the
other statins get published, or, if they slip through, they are instantly
attacked and prefaced by journal editorials as 'flawed.' YMMV

http://www.nytimes.com/2003/11/04/health/04CND-
CHOL.html?ex=1068613200&en=5509e0dc62883210&ei=5062&partner=GOOGLE>
Study Finds New Drug Acts Quickly on Clogged Arteries

Test Achieves Cholesterol Breakthrough
http://www.foxnews.com/story/0,2933,102243,00.html

New treatment works like 'liquid Drano for arteries'
Experiment injected 'good' cholesterol into heart patients
http://www.cnn.com/2003/HEALTH/11/04/cholesterol.breakthrough.ap/index.html

http://story.news.yahoo.com/news?tmpl=story&cid=571&ncid=751&e=1&u=/nm/20031105/hl_nm/health_esperion_dc
Drug Appears to Unclog Arteries - Study

The previous study on this drug is reported in Pub Med at:

Intramural delivery of recombinant apolipoprotein A-IMilano/phospholipid
complex (ETC-216) inhibits in-stent stenosis in porcine coronary
arteries.
Circulation. 2003 May 27;107(20):2551-4. Epub 2003 May 12.
PMID: 12742990 Kaul S, Rukshin V, Santos R, Azarbal B, Bisgaier CL,
Johansson J, Tsang VT, Chyu KY, Cercek B, Mirocha J, Shah PK.
Vascular Physiology and Thrombosis Research Laboratory of the
Atherosclerosis Research Center, Cedars-Sinai Medical Center, Los
Angeles,
Calif 90048, USA. [email hidden]

Sharon Hope said:

New drug heralded as a miracle drug for opening clogged arteries.

Essentially, they ADDED cholesterol, the "good" HDL, to patients, and their
arteriosclerosis blockages quickly melted away.

Note, though, folks. Apparently just giving people HDL is not patentable, so
no drug company would look into it because there would be no profits. This
is the only drug, except one by Pfizer, that has a patentable version of
HDL.

In preclinical models, this particular form of HDL worked better.

Quoted message said:

Beware getting too enthused about this at first, though. Suddenly the
Lipitor cheerleaders are using the same unprofessional medical superlatives
about this drug as, "Astonishing", "Amazing", and "Holy Grail".

sometimes scientific results really are that way.

Quoted message said:

These are
exactly the same cast of characters who have made it their business to be
sure that no honest studies that show negative effects of Lipitor or the
other statins get published, or, if they slip through, they are instantly
attacked and prefaced by journal editorials as 'flawed.' YMMV

That's ridiculous and going from skepticism to conspiracy theory.

The lead author of the present study on the modified HDL infusion
insisted that the CEO of the sponsoring company wouldn't be informed
of the results before the article was actually in press.

He doesn't like to take pharmaceutical company money.

Quoted message said:

nytimes.com04CND CHOL.htmlOpen ↗
Study Finds New Drug Acts Quickly on Clogged Arteries

Test Achieves Cholesterol Breakthrough
http://www.foxnews.com/story/0,2933,102243,00.html

New treatment works like 'liquid Drano for arteries'
Experiment injected 'good' cholesterol into heart patients
http://www.cnn.com/2003/HEALTH/11/04/cholesterol.breakthrough.ap/index.html

http://story.news.yahoo.com/news?tmpl=story&cid=571&ncid=751&e=1&u=/nm/20031105/hl_nm/health_esperion_dc
Drug Appears to Unclog Arteries - Study

The previous study on this drug is reported in Pub Med at:

Intramural delivery of recombinant apolipoprotein A-IMilano/phospholipid
complex (ETC-216) inhibits in-stent stenosis in porcine coronary arteries.
Circulation. 2003 May 27;107(20):2551-4. Epub 2003 May 12.
PMID: 12742990 Kaul S, Rukshin V, Santos R, Azarbal B, Bisgaier CL,
Johansson J, Tsang VT, Chyu KY, Cercek B, Mirocha J, Shah PK.
Vascular Physiology and Thrombosis Research Laboratory of the
Atherosclerosis Research Center, Cedars-Sinai Medical Center, Los Angeles,
Calif 90048, USA. [email hidden]

Dr Chaos <[email hidden]> wrote in
news:[email hidden]:

Quoted message said:

Sharon Hope said:

New drug heralded as a miracle drug for opening clogged arteries.

Essentially, they ADDED cholesterol, the "good" HDL, to patients, and
their arteriosclerosis blockages quickly melted away.

Note, though, folks. Apparently just giving people HDL is not
patentable, so no drug company would look into it because there would
be no profits. This is the only drug, except one by Pfizer, that has
a patentable version of HDL.

In preclinical models, this particular form of HDL worked better.

The administration of HDL could be patentable if it meets patenting
criteria (novel, useful, non-obvious).

There is more than one similar compound in development by this company -
they are hedging their bets because they know that any one of them may
not work. As well, by using a recombinant source the regulatory path is
somewhat easier.

Quoted message said:

Quoted message said:

Beware getting too enthused about this at first, though. Suddenly the
Lipitor cheerleaders are using the same unprofessional medical
superlatives about this drug as, "Astonishing", "Amazing", and "Holy
Grail".

sometimes scientific results really are that way.

Or is the media putting words in people's mouths (or the other great,
quoting out of context). And a minor, but important quibble - I think
this is a biological not a drug.

But also keep in mind that these are phase II results in a small group
for a short period of time. The measure was change in atheroma size.
And while the change in atheroma volume was statistically significant, it
does not seem too huge. From the study:
The absolute reduction in atheroma volume in the combined treatment
groups was -14.1 mm3 or a 4.2% decrease from baseline (P<.001).

[Or an average change from 336mm3 to 322mm3]

So there are more questions to be answered such as:
For longer treatment periods, does the atheroma keep shrinking?
Is the effect permanent, or is ongoing treatment required?
Do patients eventually become tolerant of the treatment requiring larger
doses or losing all effect?
And the big one - do morbidity and mortality change?

Nigel said:

Dr Chaos <[email hidden]> wrote in
news:[email hidden]:

Quoted message said:

Sharon Hope said:

New drug heralded as a miracle drug for opening clogged arteries.

Essentially, they ADDED cholesterol, the "good" HDL, to patients, and
their arteriosclerosis blockages quickly melted away.

Note, though, folks. Apparently just giving people HDL is not
patentable, so no drug company would look into it because there would
be no profits. This is the only drug, except one by Pfizer, that has
a patentable version of HDL.

In preclinical models, this particular form of HDL worked better.

The administration of HDL could be patentable if it meets patenting
criteria (novel, useful, non-obvious).

There is more than one similar compound in development by this company -
they are hedging their bets because they know that any one of them may
not work. As well, by using a recombinant source the regulatory path is
somewhat easier.

Quoted message said:

Quoted message said:

Beware getting too enthused about this at first, though. Suddenly the
Lipitor cheerleaders are using the same unprofessional medical
superlatives about this drug as, "Astonishing", "Amazing", and "Holy
Grail".

sometimes scientific results really are that way.

Or is the media putting words in people's mouths (or the other great,
quoting out of context). And a minor, but important quibble - I think
this is a biological not a drug.

Quoted message said:

But also keep in mind that these are phase II results in a small group
for a short period of time. The measure was change in atheroma size.
And while the change in atheroma volume was statistically significant, it
does not seem too huge. From the study:
The absolute reduction in atheroma volume in the combined treatment
groups was -14.1 mm3 or a 4.2% decrease from baseline (P<.001).

[Or an average change from 336mm3 to 322mm3]

So there are more questions to be answered such as:
For longer treatment periods, does the atheroma keep shrinking?
Is the effect permanent, or is ongoing treatment required?
Do patients eventually become tolerant of the treatment requiring larger
doses or losing all effect?
And the big one - do morbidity and mortality change?

This study was to get funding for a big phase III which would
answer those.

Nigel said:

Dr Chaos <[email hidden]> wrote in
news:[email hidden]:

Quoted message said:

Sharon Hope said:

New drug heralded as a miracle drug for opening clogged arteries.

Essentially, they ADDED cholesterol, the "good" HDL, to patients, and
their arteriosclerosis blockages quickly melted away.

Note, though, folks. Apparently just giving people HDL is not
patentable, so no drug company would look into it because there would
be no profits. This is the only drug, except one by Pfizer, that has
a patentable version of HDL.

In preclinical models, this particular form of HDL worked better.

The administration of HDL could be patentable if it meets patenting
criteria (novel, useful, non-obvious).

There is more than one similar compound in development by this company -
they are hedging their bets because they know that any one of them may
not work. As well, by using a recombinant source the regulatory path is
somewhat easier.

How does a scientist make similar compounds to natural HDL and what other
similar compound to they have in development?

Quoted message said:

Quoted message said:

Quoted message said:

Beware getting too enthused about this at first, though. Suddenly the
Lipitor cheerleaders are using the same unprofessional medical
superlatives about this drug as, "Astonishing", "Amazing", and "Holy
Grail".

sometimes scientific results really are that way.

Or is the media putting words in people's mouths (or the other great,
quoting out of context). And a minor, but important quibble - I think
this is a biological not a drug.

But also keep in mind that these are phase II results in a small group
for a short period of time. The measure was change in atheroma size.
And while the change in atheroma volume was statistically significant, it
does not seem too huge. From the study:
The absolute reduction in atheroma volume in the combined treatment
groups was -14.1 mm3 or a 4.2% decrease from baseline (P<.001).

[Or an average change from 336mm3 to 322mm3]

So there are more questions to be answered such as:
For longer treatment periods, does the atheroma keep shrinking?
Is the effect permanent, or is ongoing treatment required?
Do patients eventually become tolerant of the treatment requiring larger
doses or losing all effect?
And the big one - do morbidity and mortality change?

interesting perspective
--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice

"Patrick Blanchard, M.D." <[email hidden]> wrote in
news:[email hidden]:

Quoted message said:

Nigel said:

There is more than one similar compound in development by this
company - they are hedging their bets because they know that any one
of them may not work. As well, by using a recombinant source the
regulatory path is somewhat easier.

How does a scientist make similar compounds to natural HDL and what
other similar compound to they have in development?

They have three products in clincal development. See esperion.com for
further information.

Quoted message said:

Quoted message said:

But also keep in mind that these are phase II results in a small
group for a short period of time. The measure was change in atheroma
size. And while the change in atheroma volume was statistically
significant, it does not seem too huge. From the study:
The absolute reduction in atheroma volume in the combined treatment
groups was -14.1 mm3 or a 4.2% decrease from baseline (P<.001).

[Or an average change from 336mm3 to 322mm3]

So there are more questions to be answered such as:
For longer treatment periods, does the atheroma keep shrinking?
Is the effect permanent, or is ongoing treatment required?
Do patients eventually become tolerant of the treatment requiring
larger doses or losing all effect?
And the big one - do morbidity and mortality change?

interesting perspective

These are the questions that came to my mind when I read the study. I
often find that hearing/seeing science and medicine reported in the media
generates more questions and provides precious little real information.
I prefer to go to the source literature and do a critical evaluation, a
very brief synopsis of the results are presented here.

So, back to you; if a patient hears/sees this in the media and asks you
about it, what would you tell them?

Nigel said:

"Patrick Blanchard, M.D." <[email hidden]> wrote in
news:[email hidden]:

Quoted message said:

Nigel said:

There is more than one similar compound in development by this
company - they are hedging their bets because they know that any one
of them may not work. As well, by using a recombinant source the
regulatory path is somewhat easier.

How does a scientist make similar compounds to natural HDL and what
other similar compound to they have in development?

They have three products in clincal development. See esperion.com for
further information.

Quoted message said:

Quoted message said:

But also keep in mind that these are phase II results in a small
group for a short period of time. The measure was change in atheroma
size. And while the change in atheroma volume was statistically
significant, it does not seem too huge. From the study:
The absolute reduction in atheroma volume in the combined treatment
groups was -14.1 mm3 or a 4.2% decrease from baseline (P<.001).

[Or an average change from 336mm3 to 322mm3]

So there are more questions to be answered such as:
For longer treatment periods, does the atheroma keep shrinking?
Is the effect permanent, or is ongoing treatment required?
Do patients eventually become tolerant of the treatment requiring
larger doses or losing all effect?
And the big one - do morbidity and mortality change?

interesting perspective

These are the questions that came to my mind when I read the study. I
often find that hearing/seeing science and medicine reported in the media
generates more questions and provides precious little real information.
I prefer to go to the source literature and do a critical evaluation, a
very brief synopsis of the results are presented here.

So, back to you; if a patient hears/sees this in the media and asks you
about it, what would you tell them?

That it emphasizes the importance of HDL as an independent risk factor in
atherosclerosis!
--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
http://www.familydoctor.org/blanchard

"Patrick Blanchard, M.D." <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Nigel said:

"Patrick Blanchard, M.D." <[email hidden]> wrote in
news:[email hidden]:

Quoted message said:

On Wed, 05 Nov 2003 21:49:04 GMT, Nigel <[email hidden]> wrote:

>
> There is more than one similar compound in development by this
> company - they are hedging their bets because they know that any one
> of them may not work. As well, by using a recombinant source the
> regulatory path is somewhat easier.

How does a scientist make similar compounds to natural HDL and what
other similar compound to they have in development?

They have three products in clincal development. See esperion.com for
further information.

Quoted message said:

>
> But also keep in mind that these are phase II results in a small
> group for a short period of time. The measure was change in atheroma
> size. And while the change in atheroma volume was statistically
> significant, it does not seem too huge. From the study:
> The absolute reduction in atheroma volume in the combined treatment
> groups was -14.1 mm3 or a 4.2% decrease from baseline (P<.001).
>
> [Or an average change from 336mm3 to 322mm3]
>
> So there are more questions to be answered such as:
> For longer treatment periods, does the atheroma keep shrinking?
> Is the effect permanent, or is ongoing treatment required?
> Do patients eventually become tolerant of the treatment requiring
> larger doses or losing all effect?
> And the big one - do morbidity and mortality change?
>
>
>
>

interesting perspective

These are the questions that came to my mind when I read the study. I
often find that hearing/seeing science and medicine reported in the

media

Quoted message said:

Quoted message said:

generates more questions and provides precious little real information.
I prefer to go to the source literature and do a critical evaluation, a
very brief synopsis of the results are presented here.

So, back to you; if a patient hears/sees this in the media and asks you
about it, what would you tell them?

That it emphasizes the importance of HDL as an independent risk factor in
atherosclerosis!

But I thought the people studied in Northern Italy had LOW HDL or did I hear
incorrectly?

Quoted message said:

--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
http://www.familydoctor.org/blanchard

"Paul E. Lehmann" <[email hidden]> wrote in part:

Quoted message said:

Quoted message said:

Quoted message said:

So, back to you; if a patient hears/sees this in the media and asks you
about it, what would you tell them?

That it emphasizes the importance of HDL as an independent risk factor in
atherosclerosis!

But I thought the people studied in Northern Italy had LOW HDL or did I hear
incorrectly?

You heard right. But the addition of the HDL-like compound to the lipids of
people with CAD (raising their HDL) produced regression. So, at least some HDL
is protective--there is a positive effect.

As far as I know, no manipulations were done on the lucky folks in Italy...
--
Jim Chinnis Warrenton, Virginia, USA

Nigel said:

These are the questions that came to my mind when I read the study. I
often find that hearing/seeing science and medicine reported in the media
generates more questions and provides precious little real information.
I prefer to go to the source literature and do a critical evaluation, a
very brief synopsis of the results are presented here.

So, back to you; if a patient hears/sees this in the media and asks you
about it, what would you tell them?

I'm not a doctor, but I think the study emphasizes the key role
of raising HDL for the long run, and that the patient and doctor
should manage HDL aggressively.

Personally I got a multivitamin with extra niacin and will ask
my GP about HDL testing.

Paul E. Lehmann said:

But I thought the people studied in Northern Italy had LOW HDL or did I hear
incorrectly?

There was a subgroup of people with a genetic mutation who *appeared*
to have low HDL despite good health. It turned out that they had a
mutant HDL which didn't show up on the standard test for various
reasons, and this mutated HDL may be even more efficacious than
ordinary HDL.

I don't think that HDL is a single molecule anyway. The company
bioengineered production of a pure specific form of the HDL which
was found in the genomes of the northern Italian families.

Dr Chaos said:

Nigel said:

These are the questions that came to my mind when I read the study. I
often find that hearing/seeing science and medicine reported in the
media generates more questions and provides precious little real
information. I prefer to go to the source literature and do a critical
evaluation, a very brief synopsis of the results are presented here.

So, back to you; if a patient hears/sees this in the media and asks you
about it, what would you tell them?

I'm not a doctor, but I think the study emphasizes the key role
of raising HDL for the long run, and that the patient and doctor
should manage HDL aggressively.

Personally I got a multivitamin with extra niacin and will ask
my GP about HDL testing.

I wish there was a way to boost HDL more efficiently with one med, because
it seems to me that the only way to do so with medication is try and push
the LDL down, and adding omega3 fatty acids hoping the HDL will go up.
Niacin seems to be the winner here for focusing on the HDL however when
working just with meds.

BTW, you can have your lipid profile drawn without a prescription.
Insurance companies should reimburse people to do so a few times a year,
but who said they were a logical group anyway.

--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice
http://www.familydoctor.org/blanchard