Sometimes, physicians become patients themselves. I became my own patient and the valuable personal lesson learned became a professional crusade. My own contribution to healthcare reform started in 2000 when my journey to prevention began.

 

As a patient

 I tried all 6 statin drugs and experienced muscle aches, muscle weakness and muscle cramps with five of them. I am quite familiar what patients complain about. Nearly 98% of patients can take at least one statin without significant side effects - like myself, I can tolerate at least one of statin drugs available. And because I endured and overcame the hot flushes and itching with niacin for nearly a year before they dissipated, I am able to relate more with my patients when they started taking niacin and coach them to persevere a little bit more.

 

I had EBT (ultrafast cardiac CT without constrast) for Coronary Artery Calcification because it was offered for free. To my surprise, I had significant calcium score. As a result, I used aggressive combination therapy to halt disease progression and even cause some regression by reducing my LDL-P below 1,000, my LDL-c below 70 and raising my HDL-c to over 50. I became personally convinced that ultrafast cardiac CT, not the more expensive nuclear stress, is the better tool for detecting subclinical coronary heart disease in patients without any cardiac symptoms.

 

When my patients asked me - what is your lipid profile, I showed them this. LDL-c from 145 to about 100 and then dropping it further down to 40. Raising low HDL-c from about 30 to 57 in about a year. Click here for most recent lipid profile.

As a cardiologist

Our practice participated in a NCEP compliance study in 2000. Although there was an intent to treat all our CHD patients to LDL goal of less than 100, I was surprised to uncover that a large large treatment gap exist even in our practice. The intention to treat did not translate to actual treatment to goal. I made a professional decision to find a practical and cost effective method of implementing the NCEP ATP guidelines in my clinical practice in 2001 and to get as many patients to goal. With just plain determination and thinking-out-of -the-box, ACCEPT Clinical Management System slowly evolved while making constant adjustments over time. I joined SELA in 2002 before there was NLA and before NELA. I visited several functioning lipid clinics. By 2005, 85% of our high risk patients reached LDL target of less than 100; 33% were below 70; more patients were below 50 than over 130.

 

This was accomplished without hiring a lipid nurse. Preventive lipid therapy was integrated in a normal cardiology visit.

 

Event rate had dropped noticeably by the 3rd year - first noticed by our interventionalist. Now on the 7th year, event reduction had dropped markedly.

 

The cost-effective, non-traditional cholesterol clinic that I've developed is, what I believe, a "best practice model". Most adult medical practices can be easily taught to adopt this model without hiring additional personnel. 

Personal and professional lessons learned:

1. We, physicians, can all do a much better job.

2. The future of cardiovascular disease management is prevention.

3. That future is already here.