Our Optimal Medical Therapy                                                                   

Proportionality between the severity of risk and intensity of medical therapy - the greater the risk, the more intense the medical therapy.

Optimal medical therapy includes LDL-c/LDL-p cholesterol lowering therapy, diabetes control (HgbA1c less than 6.5), blood pressure control (systolic BP less than 130), smoking cessation, regular exercise, weight control and stress management.

Optimal medical therapy prescribed by clinicians are not all the same. It depends on their experience, their training, whether they have a clinical management system or not (like daily self chart audit, etc.) or the financial impact of large reductions in heart attack and stroke patients to them or their employer’s finances. Atherosclerosis is the goose that lays the golden egg. Heart attack and stroke have fueled and sustained the growth of a large cardiovascular healthcare industry for decades and unwilling to give it up - it is financial dependent of these cardiovascular events but these events are now largely preventable. It poses a threat to their guaranteed revenue stream. The hospital charges for a heart attack or stroke can easily exceed $150,000, heart bypass surgery over $200,000, stenting over $50,000, etc.     

LDL-c LDL-p Reduction is the Cornerstone of CVD Prevention

Steno-2 showed that lipid management accounts for over 70% reduction of cardiovascular events, diabetes and systolic blood pressure control about 20% each. That has been our experience as well since 2001. 

More Particles, More Plaques

Plaques by their nature want to grow and they do. Some will rupture suddenly and cause these events. Plaques are not affected by what dose of statin or type of statin you are using, only the amount of LDL cholesterol or LDL particles floating in the blood. More LDL cholesterol or LDL particles, more will get into the coronary arteries and into the plaques and fuel the inflammatory process.

Our goal is create our optimal medical therapy barrier so that it keeps our patients on the left side and prevent them from crossing into the right side.

Let us not forget the lessons learned from the COURAGE Trial - titrate statin dose, lower LDLc is better.

COURAGE Trial - Patient Characteristics
COURAGE Trial - The Conclusion
COURAGE4

Let us not forget the lessons learned from the COURAGE Trial - not fixing statin dosing but titrating the dose to get to lower LDL-c levels. Otherwise, the results would have been different. The 2013 ACC/AHA guidelines disregarded or forgot the important lesson from this landmark trial and sets us back by more than a decade in our fight against heart disease.

© Rolando L. deGoma MD  2018     www.deGomaMD.com     Capital Cardiology Associates     Princeton Physicians Organization