During my medical training rather than consider a third year as a chief medical resident I elected to do a year of hematology-oncology. I thought hematology- oncology would expand my experience and better prepare me for a career in medicine and in retrospect I was correct. Those were the years chemotherapy for cancer and hematological disorders switched from single drug to combination therapy (MOPP COPP etc) with amazingly improved mortality. Thus I did not develop a mental set against expansion of combination therapy.
In the year 2000 with the availability of Advanced Lipid Testing and before the appearance of multiple medical organizational guidelines, which I find confusing and less then definitive, I treated the most common cause for heart attacks in my and any similar cardiology practice Familial Combined Hyperlipidemia (FCH) very aggressively with multiple medications directed at correction of undesirable biochemical abnormalities and lipoproteins by favorably altering gene expression
In February 2016 I attended a continuing medical education course. During the CME course, a case was presented which was an extreme incompletely treated case of FCH (Familial Combined Hyperlipidemia)or in my opinion the Metabolic Syndrome. My initial response was the treatment of this problem would be a piece of cake. This male patient on a statin had an LDL-C of 63 mg/dL(best 1-2 %) with an HDL of 32 mg/dL and a TG of 300 mg/dL. No other lipid parameters were obtained. Well, this case happened to be the prominent TV commentator Tim Russet and as you may know he met his demise shortly thereafter.
HIs untimely death caused an uproar which with time has been repressed and forgotten and little really learned, as are most untoward events. My FCH experience as documented by my websites includes innumerable successful treatments of severe metabolic syndromes e.g. My Metabolic Syndrome Journey.(A 50 minute presentation) because I have and continue to Incorporate the principles of combination (three or greater medications) therapy initiated by that one year of hematology-oncology
The organizer of the above CMR course mentioned that the news media was calling into question the LDL hypothesis and in my opinion was well they should.The attending faculty was then polled as well as the participants. Most of the faculty emphasized therapeutic lifestyle changes which I am sure the patient had been attempting for years and which would not have come close to correcting his metabolic abnormalities. Most of the course participants would have added to this patient’s single statin regimen, a single medication, the flavor of the month treatment at the present time, Omega-3 fatty acids, not my first choice. One panelist, a retired prominent researcher, amazingly dismissed both the AIM-HIGH trial and HP2-Thrive by recommending Niaspan.
I was stunned by the vacillation, variation and lack of assertiveness of the panel, except for the retired researcher. I was tempted to initiate a more in depth discussion but had second thoughts about possibly disrupting the meeting about a topic that would most certainly have exceeded the time allowed, but should have been discussed more in detail with greater audience input.
Recently in preparation for a successful recertification examination in Clinical Lipidology I was required to become familiar with the many National and International Cardiovascular Guidelines and I must say if I did not rely upon my experience predating the large onslaught of consensus panel guidelines, I also would have similar thoughts like most individuals on that panel.
Contrary to the approach with Tim Russert i.e. a single Statin, we need to look at alternatives that WORK for each individual and not rely upon exceedingly variable guidelines from different National and International Consensus Groups who apply one- size-fits-all and now rely only upon Mega-Trials allowing a clear advantage to the big- money interests in medicine.
Just look around you, we are far from all biochemically and genetically similar. So, how can one-size-fits-all? Answer: it doesn’t