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The Curbsiders Internal Medicine Podcast | MedEd | FOAMed | Internist | Hospitalist | Primary Care | Family Medicine

Supercharge your learning and enhance your practice with this Internal Medicine Podcast featuring board certified Internists as they interview national and international experts to bring you clinical pearls and practice changing knowledge. Doctors Matthew Watto, Stuart Brigham, and Paul Williams deliver some knowledge food for your brain hole. No boring lectures here, just high value content and a healthy dose of humor. Fantastic podcast for Internal Medicine, Family Medicine, Primary Care, and Hospital Medicine. Topics include heart disease, obesity, diabetes, cardiac imaging, migraines, fibromyalgia, hypertension, cholesterol, osteoporosis, insomnia, testosterone, functional medicine, dementia, and more!
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Now displaying: July, 2016

Supercharge your learning and enhance your practice with this Internal Medicine Podcast featuring board certified Internists as they interview national and international experts to bring you clinical pearls and practice changing knowledge. Doctors Matthew Watto, Stuart Brigham, and Paul Williams deliver some knowledge food for your brain hole.

thecurbsiders@gmail.com

Jul 25, 2016

Summary:

In this episode our guest is Master Lipidologist, Dr. Peter Howard Jones from Baylor College of Medicine and the National Lipid Association. My guest host is Dr. Paul Williams, Clinician Educator extraordinaire from Philadelphia. We explore everything you’ll ever want to know about cholesterol and lipids. Are statins still king when it comes to cholesterol lowering? Should we be rushing to use PCSK9 inhibitors? Should we throw away older drugs like fibrates? Are nonpharmacologic therapies like niacin and fish oil worthwhile? Join us for this extensive conversation.

 

Disclosures:

Dr. Jones is the Chief Science Officer at the National Lipid Association. He has served as a scientific advisor to Merck, Amgen and Sanofi.

 

Learning objectives:

1. Identify each individual's risk for cardiovascular disease and counsel them on benefits of therapy.

2. Learn to lower atherogenic lipids by any means necessary and understand the effects of the common lipid lowering drugs

3. Effectively counsel patients on benefits of lipid lowering drugs to promote patient buy in and adherence.

 

Clinical Pearls

1. Omega 3 fatty acids at 1,000 mg daily or more is useful for prevention of sudden death in post ACS patients.

2. Omega 3 fatty acids at dose of 4,000 mg per day is needed to lower triglycerides. Indicated if TG remain above 500 on first line therapy.

3. Hypertriglyceridemia with level above 500 on optimal statin dose, then consider addition of fibrate and/or omega-3 fatty acids. Uncertain clinical benefit in patient with moderate elevation (200-300) of triglycerides.

4. Statin intolerance can be overcome in most patients using the following methods:

a. Same statin at lower dose

b. Different statin

c. Use of rosuvastatin or atorvastatin 3 times weekly

5. Statins are safe to take for at least 20 years and probably longer (this data is still being collected, but will be available in the future)

6. Withdrawal of statins at the end of life is not harmful and may be beneficial.

 

Links from the Show:

 

Studies that used fibrates for preventions of CV events:

Helsinki Heart Study for primary prevention NEJM 1987

VA HIT Study for secondary prevention NEJM 1999

 

Withdrawal of statins at the end of life

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4618294/

 

Expert Consensus on use of Non-Statin Drugs

http://www.acc.org/latest-in-cardiology/ten-points-to-remember/2016/03/30/11/58/2016-acc-expert-consensus-decision-pathway-on-the-role-of-nonstatin

 

National Lipid Association recommendations for patient-centered management of dyslipidemia

https://www.lipid.org/sites/default/files/Recommendations-Part-1.pdf

 

Recommended websites

National Lipid Association

The Heart.org (Medscape)

Journal of Clinical Lipidology

Jul 8, 2016

Treat C. diff, choose the correct antibiotic regimen, and identify who needs fecal transplant as we “curbside” Gastroenterologist, Dr. Adam Ehrlich from Temple University Hospital. On the show, we cover the ins-and-outs of procuring, preparing and performing transplants as well as future directions in this burgeoning field e.g. IBD, obesity, metabolic syndrome and more.

Take Home Points:

  1. Clostridium difficile infection is the only indication for which FMT is allowed by the FDA without special authorization
  2. FMT is VERY effective in these C difficile patients compared to standard of care (approximately 90% cure vs 30%)
  3. We are just beginning to understand the role of the microbiome in human health, and I anticipate many changes in the years ahead where modifying the microbiome will be used to help treat a number of diseases.

 Links from the Show:

Recommended reading...

NEJM Journal Watch for Gastroenterology - register here

Review on novel uses for fecal transplantation

Rossen NG, et al. Fecal microbiota transplantation as novel therapy in gastroenterology: A systematic review. World J Gastroenterol. 2015 May 7;21(17):5359-71. doi: 10.3748/wjg.v21.i17.5359.

Randomized controlled trial of fresh vs frozen fecal transplantation

Fresh vs Frozen Fecal Microbiota Transplant for C diff Recurrent C difficile infection. JAMA 2016

Review on mechanisms for gut microbiota on metabolic syndromes

Qian LL, et al. Effect of the Gut Microbiota on Obesity and Its Underlying Mechanisms: an Update. Biomed Environ Sci. 2015 Nov;28(11):839-47. doi: 10.3967/bes2015.117.

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