Zocor - Is there a generic in the works

simvastatin....... Zocor generic

Merck Frosst no longer exists..... the generic is available though

"Pat" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

What's the story on Zocor. I heard years ago that it was set to be

approved

Quoted message said:

for generics at lower prices, or has the FDA and the pols been paid
convinced otherwise?

I am assuming you are also aware of lovastatin, the first statin
prescription drug made generic. It is less expensive if you obtain the
80 mg tab and split in half for a 40 mg dose, which is the standard
dose. Many pharmacies do not carry the 80 tab and will tell you 'it is
not available', so ask around.

As to non-prescription statins, there are some interesting compounds
that act just like statins; policosanols and red-yeast-rice extracts.
These are available online and in my experience have lowered LDL and
increased HDL to goal for some patients. They can act as a 'booster'
for lower dose prescription statins too. I find it interesting that
red-yeast-rice, although used in Eurasia before written history, was
banned by the FDA by the makers of the then patented lovastatin
(Mevacor). Red-yeast-rice has lovastatin-like compounds that made the
pharmaceutical company making Mevacor nervous enough for profit that
they pushed the 'patented' issue until RYR was banned (I wonder how
much of the cost of lobbying efforts were passed on to the consumers
at the time) even though RYR had been on the market before Mevacor was
offered.

http://www.wholehealthmd.com/news/viewarticle/1,1513,29,00.html

hope this helps. pb

"Tiger Lily" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

simvastatin....... Zocor generic

I entered the generic name into the input field and got the following.

http://www.drugstore.com/pharmacy/prices/drugprice.asp?ndc=00006074082&trx=1Z5006

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

Quoted message said:

I am assuming you are also aware of lovastatin, the first statin
prescription drug made generic. It is less expensive if you obtain the
80 mg tab and split in half for a 40 mg dose, which is the standard
dose. Many pharmacies do not carry the 80 tab and will tell you 'it is
not available', so ask around.

As to non-prescription statins, there are some interesting compounds
that act just like statins; policosanols and red-yeast-rice extracts.
These are available online and in my experience have lowered LDL and
increased HDL to goal for some patients. They can act as a 'booster'
for lower dose prescription statins too. I find it interesting that
red-yeast-rice, although used in Eurasia before written history, was
banned by the FDA by the makers of the then patented lovastatin
(Mevacor). Red-yeast-rice has lovastatin-like compounds that made the
pharmaceutical company making Mevacor nervous enough for profit that
they pushed the 'patented' issue until RYR was banned (I wonder how
much of the cost of lobbying efforts were passed on to the consumers
at the time) even though RYR had been on the market before Mevacor was
offered.

http://www.wholehealthmd.com/news/viewarticle/1,1513,29,00.html

hope this helps. pb

I have tried alternatives but Zocor seems to work well. Also, they claim a
study that brags about Zocor being more effective than the competitive meds.
Is it true, or hype?

http://www.zocor.com/simvastatin/zocor/consumer/heartprotectionstudy/study_results/index.jsp

Pat said:

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

Quoted message said:

I am assuming you are also aware of lovastatin, the first statin
prescription drug made generic. It is less expensive if you obtain the
80 mg tab and split in half for a 40 mg dose, which is the standard
dose. Many pharmacies do not carry the 80 tab and will tell you 'it is
not available', so ask around.

As to non-prescription statins, there are some interesting compounds
that act just like statins; policosanols and red-yeast-rice extracts.
These are available online and in my experience have lowered LDL and
increased HDL to goal for some patients. They can act as a 'booster'
for lower dose prescription statins too. I find it interesting that
red-yeast-rice, although used in Eurasia before written history, was
banned by the FDA by the makers of the then patented lovastatin
(Mevacor). Red-yeast-rice has lovastatin-like compounds that made the
pharmaceutical company making Mevacor nervous enough for profit that
they pushed the 'patented' issue until RYR was banned (I wonder how
much of the cost of lobbying efforts were passed on to the consumers
at the time) even though RYR had been on the market before Mevacor was
offered.

http://www.wholehealthmd.com/news/viewarticle/1,1513,29,00.html

hope this helps. pb

I have tried alternatives but Zocor seems to work well. Also, they claim
a
study that brags about Zocor being more effective than the competitive
meds.
Is it true, or hype?

http://www.zocor.com/simvastatin/zocor/consumer/heartprotectionstudy/study_results/index.jsp

You are asking "do statins have a class effect?", or "are all statins equal
in efficacy?".

Yes, I believe all statins are equally effective, a also believe a
phamaceutical rep can play physicians like parrots.

Statins have at least 2 important roles; lowering cholesterol and
stabilizing vulnerable plaques. Personally I believe the latter to be more
important than the first. You might want to check out the CIMT thead too.

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

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

Quoted message said:

You are asking "do statins have a class effect?", or "are all statins

equal

Quoted message said:

in efficacy?".

Yes, I believe all statins are equally effective, a also believe a
phamaceutical rep can play physicians like parrots.

Statins have at least 2 important roles; lowering cholesterol and
stabilizing vulnerable plaques. Personally I believe the latter to be more
important than the first. You might want to check out the CIMT thead too.

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

I suspect that all statins are a family that have common benefits and work
in similar ways. However, the fact that doctors recommend one vs. the other
has me wondering if its because of the pharmaceutical reps convincing them
about their preferences or that some patients react differently and/or
register higher or lower cholesterol rates when taking more than one statin.
Have you seen data to corroborate this?

Pat said:

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

Quoted message said:

You are asking "do statins have a class effect?", or "are all statins

equal

Quoted message said:

in efficacy?".

Yes, I believe all statins are equally effective, a also believe a
phamaceutical rep can play physicians like parrots.

Statins have at least 2 important roles; lowering cholesterol and
stabilizing vulnerable plaques. Personally I believe the latter to be
more
important than the first. You might want to check out the CIMT thead
too.

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

I suspect that all statins are a family that have common benefits and
work
in similar ways. However, the fact that doctors recommend one vs. the
other
has me wondering if its because of the pharmaceutical reps convincing
them
about their preferences or that some patients react differently and/or
register higher or lower cholesterol rates when taking more than one
statin.
Have you seen data to corroborate this?

Yes, there is plenty to be found on prescribing practices at www.pubmed.gov
I refused to see pharm. reps 6 or 7 years ago because of this issue. It is
not uncommon to see a "hot" new drug prescribed in groups of physicians
when an inexpensive generic is just as good if not better.
--
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice

M.D. said:

You are asking "do statins have a class effect?", or "are all statins equal
in efficacy?".

Yes, I believe all statins are equally effective, a also believe a
phamaceutical rep can play physicians like parrots.

Statins have at least 2 important roles; lowering cholesterol and
stabilizing vulnerable plaques. Personally I believe the latter to be more
important than the first. You might want to check out the CIMT thead too.

My intuition agrees with you but eventually it's "data talk, [censored]
walks"

Are there good surrogate or direct clinical markers for "stabilizing
vulnerable plaques" as opposed to blood lipids?

Were these tested in either

a) registrational
b) post-approval

clinical studies by the pharmaceutical companies, or by other
sponsors?

Dr Chaos said:

M.D. said:

You are asking "do statins have a class effect?", or "are all statins
equal in efficacy?".

Yes, I believe all statins are equally effective, a also believe a
phamaceutical rep can play physicians like parrots.

Statins have at least 2 important roles; lowering cholesterol and
stabilizing vulnerable plaques. Personally I believe the latter to be
more important than the first. You might want to check out the CIMT
thead too.

My intuition agrees with you but eventually it's "data talk, [censored]
walks"

Are there good surrogate or direct clinical markers for "stabilizing
vulnerable plaques" as opposed to blood lipids?

A vulnerable plaque is commonly defined as a collection of 'guel' within
the intima-media complex with a fragile fibrous, or outer coating. The
intima, once supple and pliable has been replaced with fibrous like cells
that are stiffer. This guel under a thin and sickly fibrous cap is still
metabolically active, expressing certain proteins on the surface that
normally are not present on healthy intima. High resolution CIMT can
visualize fibrous capping when there is a vulnerable plaque present in the
carotid arterial beds, and is an added bonus of understanding with CIMT.
However, the abscence of plaque in the carotid beds do not preclude plaque
in the coronary or other arterial beds.

High sensitivity C-reactive protein hs.CRP and myeloperoxidase, or MPO are
very promising markers for active inflammation and vulnerability for heart
attack and stroke. I use hs.CRP to gauge progression of therapy in the
short run (every few months) and CIMT for the long haul (annually).
Unfortunately, MPO is still investigational.

So yes, there are good markers for assesing plaque stability in my opinion.

Quoted message said:

Were these tested in either

a) registrational b) post-approval

clinical studies by the pharmaceutical companies, or by other
sponsors?

This is where I believe 'class effect' of most medications should be used.
In other words, if company A underwrites a study of statin A showing rapid
decrease in hs.CRP or MPO, and is the only one published then you have to
be careful not to jump on the statin A bandwagon too quickly but hold
company A's study up to the class effect studies and help the patient make
the decision on their own. If someone asks me to decide, then I invariably
stay with the 'class effect' model.

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

Patrick said:

Dr Chaos said:

M.D. said:

You are asking "do statins have a class effect?", or "are all statins
equal in efficacy?".

Yes, I believe all statins are equally effective, a also believe a
phamaceutical rep can play physicians like parrots.

Statins have at least 2 important roles; lowering cholesterol and
stabilizing vulnerable plaques. Personally I believe the latter to be
more important than the first. You might want to check out the CIMT
thead too.

My intuition agrees with you but eventually it's "data talk, [censored]
walks"

Are there good surrogate or direct clinical markers for "stabilizing
vulnerable plaques" as opposed to blood lipids?

A vulnerable plaque is commonly defined as a collection of 'guel' within
the intima-media complex with a fragile fibrous, or outer coating. The
intima, once supple and pliable has been replaced with fibrous like cells
that are stiffer. This guel under a thin and sickly fibrous cap is still
metabolically active, expressing certain proteins on the surface that
normally are not present on healthy intima. High resolution CIMT can
visualize fibrous capping when there is a vulnerable plaque present in the
carotid arterial beds, and is an added bonus of understanding with CIMT.
However, the abscence of plaque in the carotid beds do not preclude plaque
in the coronary or other arterial beds.

Nor vice versa (ie increased CIMT does not preclude significant coronary
atherosclerotic disease).

Quoted message said:

High sensitivity C-reactive protein hs.CRP and myeloperoxidase, or MPO are
very promising markers for active inflammation and vulnerability for heart
attack and stroke. I use hs.CRP to gauge progression of therapy in the
short run (every few months) and CIMT for the long haul (annually).
Unfortunately, MPO is still investigational.

What is unfortunate about investigation?

Quoted message said:

So yes, there are good markers for assesing plaque stability in my opinion.

Neither CIMT nor hsCRP are good markers for assessing *coronary* plaque
stability, imho.

MPO might be based on the recent Cleveland Clinic study in NEJM.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

MD/PhD said:

Patrick said:

Dr Chaos said:

On Tue, 28 Oct 2003 07:59:46 -0600, Patrick Blanchard, M.D. <> wrote:
>
> You are asking "do statins have a class effect?", or "are all statins
> equal in efficacy?".
>
> Yes, I believe all statins are equally effective, a also believe a
> phamaceutical rep can play physicians like parrots.
>
> Statins have at least 2 important roles; lowering cholesterol and
> stabilizing vulnerable plaques. Personally I believe the latter to be
> more important than the first. You might want to check out the CIMT
> thead too.

My intuition agrees with you but eventually it's "data talk, [censored]
walks"

Are there good surrogate or direct clinical markers for "stabilizing
vulnerable plaques" as opposed to blood lipids?

A vulnerable plaque is commonly defined as a collection of 'guel' within
the intima-media complex with a fragile fibrous, or outer coating. The
intima, once supple and pliable has been replaced with fibrous like
cells
that are stiffer. This guel under a thin and sickly fibrous cap is still
metabolically active, expressing certain proteins on the surface that
normally are not present on healthy intima. High resolution CIMT can
visualize fibrous capping when there is a vulnerable plaque present in
the
carotid arterial beds, and is an added bonus of understanding with CIMT.
However, the abscence of plaque in the carotid beds do not preclude
plaque
in the coronary or other arterial beds.

Nor vice versa (ie increased CIMT does not preclude significant coronary
atherosclerotic disease).

increased CIMT essentially predicts risk of increased IMT of the coronary
bed. however, I do not know your reference point for 'significant' coronary
atherosclerotic disease. please explain.

Quoted message said:

Quoted message said:

High sensitivity C-reactive protein hs.CRP and myeloperoxidase, or MPO
are
very promising markers for active inflammation and vulnerability for
heart
attack and stroke. I use hs.CRP to gauge progression of therapy in the
short run (every few months) and CIMT for the long haul (annually).
Unfortunately, MPO is still investigational.

What is unfortunate about investigation?

there are no standards, or bell shaped curve to position therapy.

Quoted message said:

Quoted message said:

So yes, there are good markers for assesing plaque stability in my
opinion.

Neither CIMT nor hsCRP are good markers for assessing *coronary* plaque
stability, imho.

'good' seems too subjective a word. can you be more specific?

Thank you

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

Patrick said:

MD/PhD said:

Patrick said:

On Tue, 28 Oct 2003 18:05:08 +0000 (UTC), Dr Chaos
<[email hidden]> wrote:

> On Tue, 28 Oct 2003 07:59:46 -0600, Patrick Blanchard, M.D. <> wrote:
>>
>> You are asking "do statins have a class effect?", or "are all statins
>> equal in efficacy?".
>>
>> Yes, I believe all statins are equally effective, a also believe a
>> phamaceutical rep can play physicians like parrots.
>>
>> Statins have at least 2 important roles; lowering cholesterol and
>> stabilizing vulnerable plaques. Personally I believe the latter to be
>> more important than the first. You might want to check out the CIMT
>> thead too.
>
> My intuition agrees with you but eventually it's "data talk, [censored]
> walks"
>
> Are there good surrogate or direct clinical markers for "stabilizing
> vulnerable plaques" as opposed to blood lipids?

A vulnerable plaque is commonly defined as a collection of 'guel' within
the intima-media complex with a fragile fibrous, or outer coating. The
intima, once supple and pliable has been replaced with fibrous like
cells
that are stiffer. This guel under a thin and sickly fibrous cap is still
metabolically active, expressing certain proteins on the surface that
normally are not present on healthy intima. High resolution CIMT can
visualize fibrous capping when there is a vulnerable plaque present in
the
carotid arterial beds, and is an added bonus of understanding with CIMT.
However, the abscence of plaque in the carotid beds do not preclude
plaque
in the coronary or other arterial beds.

Nor vice versa (ie increased CIMT does not preclude significant coronary
atherosclerotic disease).

increased CIMT essentially predicts risk of increased IMT of the coronary
bed. however, I do not know your reference point for 'significant' coronary
atherosclerotic disease. please explain.

Preclude and predict risk are not synonymous.

Quoted message said:

Quoted message said:

Quoted message said:

High sensitivity C-reactive protein hs.CRP and myeloperoxidase, or MPO
are
very promising markers for active inflammation and vulnerability for
heart
attack and stroke. I use hs.CRP to gauge progression of therapy in the
short run (every few months) and CIMT for the long haul (annually).
Unfortunately, MPO is still investigational.

What is unfortunate about investigation?

there are no standards, or bell shaped curve to position therapy.

Without investigation there will be no data.

Quoted message said:

Quoted message said:

Quoted message said:

So yes, there are good markers for assesing plaque stability in my
opinion.

Neither CIMT nor hsCRP are good markers for assessing *coronary* plaque
stability, imho.

'good' seems too subjective a word. can you be more specific?

Your word choice. Something good for me in this context would have proven
clinical utility.

Quoted message said:

Thank you

You're welome.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com

MD/PhD said:

Patrick said:

MD/PhD said:

Patrick, Blanchard,, M.D., , >> wrote:

> On Tue, 28 Oct 2003 18:05:08 +0000 (UTC), Dr Chaos
> <[email hidden]> wrote:
>
> > On Tue, 28 Oct 2003 07:59:46 -0600, Patrick Blanchard, M.D. <>

Quoted message said:

> >>
> >> You are asking "do statins have a class effect?", or "are all

statins

Quoted message said:

> >> equal in efficacy?".
> >>
> >> Yes, I believe all statins are equally effective, a also believe a
> >> phamaceutical rep can play physicians like parrots.
> >>
> >> Statins have at least 2 important roles; lowering cholesterol and
> >> stabilizing vulnerable plaques. Personally I believe the latter to

be

Quoted message said:

> >> more important than the first. You might want to check out the

CIMT

Quoted message said:

> >> thead too.
> >
> > My intuition agrees with you but eventually it's "data talk,

[censored]

Quoted message said:

> > walks"
> >
> > Are there good surrogate or direct clinical markers for

"stabilizing

Quoted message said:

> > vulnerable plaques" as opposed to blood lipids?
>
> A vulnerable plaque is commonly defined as a collection of 'guel'

within

Quoted message said:

> the intima-media complex with a fragile fibrous, or outer coating.

The

Quoted message said:

> intima, once supple and pliable has been replaced with fibrous like
> cells
> that are stiffer. This guel under a thin and sickly fibrous cap is

still

Quoted message said:

> metabolically active, expressing certain proteins on the surface that
> normally are not present on healthy intima. High resolution CIMT can
> visualize fibrous capping when there is a vulnerable plaque present

in

Quoted message said:

> the
> carotid arterial beds, and is an added bonus of understanding with

CIMT.

Quoted message said:

> However, the abscence of plaque in the carotid beds do not preclude
> plaque
> in the coronary or other arterial beds.
>

Nor vice versa (ie increased CIMT does not preclude significant

coronary

Quoted message said:

atherosclerotic disease).

increased CIMT essentially predicts risk of increased IMT of the
coronary
bed. however, I do not know your reference point for 'significant'
coronary
atherosclerotic disease. please explain.

Preclude and predict risk are not synonymous.

I don't believe I said they were...

Quoted message said:

Quoted message said:

Quoted message said:

> However, the abscence of plaque in the carotid beds do not preclude
> plaque
> in the coronary or other arterial beds.

(When carotid plaques are not present, it does not mean they are absent in
the coronary and other arterial beds.)

Quoted message said:

Quoted message said:

increased CIMT essentially predicts risk of increased IMT of the
coronary
bed.

(If someone has increased carotid artery intima media thickness, there is a
higher than normal risk of having increased coronary artery intima media
thickness.)

however, you have not addressed your reference point for 'significant
coronary atherosclerotic disease'.

predict (verb)

predict, forecast, make a prediction, prognosticate, make a prognosis
foretell, prophesy, vaticinate, forebode, bode, augur, spell
foretoken, presage, portend
foreshow, foreshadow, prefigure, shadow forth, forerun, herald, harbinger,
usher in, come before
point to, betoken, typify, signify, indicate
announce, give notice, notify, advertise
forewarn, give warning, warn
look black, look ominous, lower, menace, threaten
promise, augur well, bode well, bid fair to, give hopes of, hold out hopes,
build up hopes, raise expectations, excite expectations, give hope

The Original Roget's Thesaurus of English Words and Phrases (Americanized
Version) is licensed from Longman Group UK Limited. Copyright © 1994 by
Longman Group UK Limited. All rights reserved.

preclude (verb)

exclude: exclude, preclude, make impossible

The Original Roget's Thesaurus of English Words and Phrases (Americanized
Version) is licensed from Longman Group UK Limited. Copyright © 1994 by
Longman Group UK Limited. All rights reserved.

Quoted message said:

Quoted message said:

Quoted message said:

>
> High sensitivity C-reactive protein hs.CRP and myeloperoxidase, or

MPO

Quoted message said:

> are
> very promising markers for active inflammation and vulnerability for
> heart
> attack and stroke. I use hs.CRP to gauge progression of therapy in

the

Quoted message said:

> short run (every few months) and CIMT for the long haul (annually).
> Unfortunately, MPO is still investigational.
>

What is unfortunate about investigation?

there are no standards, or bell shaped curve to position therapy.

Without investigation there will be no data.

I think we are in agreement here.

Quoted message said:

Quoted message said:

Quoted message said:

>
> So yes, there are good markers for assesing plaque stability in my
> opinion.
>

Neither CIMT nor hsCRP are good markers for assessing *coronary*

plaque

Quoted message said:

stability, imho.

'good' seems too subjective a word. can you be more specific?

Your word choice. Something good for me in this context would have
proven
clinical utility.

Perhaps I was not clear on this issue, let me explain...

CIMT has proven clinical utility.

hsCRP has proven clinical utility, although not as well validated as CIMT.

MPO has possible clinical utility, although not as well validated as hsCRP.

CIMT has not been proven capable of assesing stability of coronary plaque.
Coronary angiography is not capable of assesing the stability of coronary
plaque either. IVUS of the coronary arteries, using a radial catheter probe
at lesser axial and lateral resolution than CIMT (lower frequency) is
capable of assessing coronary plaque morphology and as you know is evolving
into a good tool to guide angioplasty and stent placement. CIMT can asses
carotid plaque morphology if performed with high resolution external 10Mhz
linear array probes or better, although you will find conflicting reports
in the literature as to the reliability of predicting hard clinical events
with interpretation of carotid plaque morphology.

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

Patrick Blanchard said:

<snip>however, you have not addressed your reference point for 'significant
coronary atherosclerotic disease'.

Disease is clinically significant when there are signs and symptoms associated
with it. Otherwise, it may still be important but not clinically significant.

Quoted message said:

<snip>

Perhaps I was not clear on this issue, let me explain...

CIMT has proven clinical utility.

Not for assessing coronary plaque stability.

Quoted message said:

hsCRP has proven clinical utility, although not as well validated as CIMT.

Not for assessing coronary plaque stability.

Quoted message said:

MPO has possible clinical utility, although not as well validated as hsCRP.

From the recent NEJM article from Cleveland Clinic, it now has proven utility
in assessing stability of coronary plaque(s) that are causing chest pain in the
acute ER setting.

Quoted message said:

CIMT has not been proven capable of assesing stability of coronary plaque.

Glad you agree.

Quoted message said:

Coronary angiography is not capable of assesing the stability of coronary
plaque either.

Correct.

Quoted message said:

IVUS of the coronary arteries, using a radial catheter probe
at lesser axial and lateral resolution than CIMT (lower frequency) is
capable of assessing coronary plaque morphology and as you know is evolving
into a good tool to guide angioplasty and stent placement.

And IVUS information of plaque lipid content does assess coronary plaque
stability.

Quoted message said:

CIMT can asses
carotid plaque morphology if performed with high resolution external 10Mhz
linear array probes or better, although you will find conflicting reports
in the literature as to the reliability of predicting hard clinical events
with interpretation of carotid plaque morphology.

Imho, you are looking at the wrong part of the body with CIMT.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

Dr. Andrew B. Chung said:

Imho, you are looking at the wrong part of the body with CIMT.

If the biochemical process is similar everywhere and there is
mechanistic correlation between states likely to cause carotid disease
as coronary disease, it should be a good proxy for increased risk
probability. Not actual disease of course.

Dr Chaos said:

Dr. Andrew B. Chung said:

Imho, you are looking at the wrong part of the body with CIMT.

If the biochemical process is similar everywhere and there is
mechanistic correlation between states likely to cause carotid disease
as coronary disease, it should be a good proxy for increased risk
probability.

Ime, the CIMT information contributes very little additively to the CAD
risk assessment ascertainable from a good history, physical exam, EKG, and
basic blood work including serum glucose and a lipid profile.

Quoted message said:

Not actual disease of course.

Of course.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

MD/PhD said:

Patrick Blanchard said:

<snip>however, you have not addressed your reference point for
'significant
coronary atherosclerotic disease'.

Disease is clinically significant when there are signs and symptoms
associated
with it. Otherwise, it may still be important but not clinically
significant.

The decades-long, slow progression of atherosclerosis, clinically silent,
without signs or symptoms is a very very significant and serious clinical
problem.

Cleve Clin J Med. 2003 May;70(5):431-4, 437-8, 440. Aggressive treatment of
atherosclerosis: the time is now.

Fonarow GC.

Ahmanson-UCLA Cardiomyopathy Center, Cardiology Fellowship Training
Program, UCLA Preventative Cardiology Program, Division of Cardiology, UCLA
Division of Cardiology 90095, USA. [email hidden]

In patients with known cardiovascular disease and those at high risk for
it, physicians must begin to treat atherosclerosis earlier, with
combination therapy of statins, aspirin, angiotensin-converting enzyme
inhibitors, and beta-blockers.

[censored] TJ, Nam BH, D'Agostino RB, Wolf PA, Lloyd-Jones DM, MacRae CA, Wilson
PW, Polak JF, O'Donnell CJ.

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12874190&dopt=Abstract

Carotid intima-media thickness is associated with premature parental
coronary heart disease: the Framingham Heart Study.
Circulation. 2003 Aug 5;108(5):572-6. Epub 2003 Jul 21. PMID: 12874190
[PubMed - indexed for MEDLINE]

Quoted message said:

Quoted message said:

<snip>

Perhaps I was not clear on this issue, let me explain...

CIMT has proven clinical utility.

Not for assessing coronary plaque stability.

I disagree with your blanket statement. You know we are discussing
statistically significant issues.

J Am Coll Cardiol. 2003 Sep 17;42(6):1026-32. Related Articles, Links
Clinical implications of carotid artery remodeling in acute coronary
syndrome: ultrasonographic assessment of positive remodeling.

Kato M, Dote K, Habara S, Takemoto H, Goto K, Nakaoka K.

Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan.
[email hidden]

OBJECTIVES: We investigated the relationship between ultrasonographic
features of the carotid artery and the angiographic features of coronary
plaques in acute coronary syndrome (ACS). BACKGROUND: The carotid intima-
media thickness (IMT) may be a marker of advanced coronary artery disease.
METHODS: Consecutive ACS patients (N = 125) underwent B-mode
ultrasonography within one week of the acute coronary event. Using a 7.5-
MHz linear array transducer, the common carotid IMT, interadventitial
diameter, and luminal diameter were examined. Carotid plaques were also
assessed. Then patients were divided into two groups based on the number of
complex plaques identified by coronary angiography. RESULTS: The carotid
IMT of 75 patients with multiple complex coronary plaques was significantly
larger than that of 50 patients with solitary plaques (p < 0.0003). The
prevalence of soft and hard carotid plaques was higher in the group with
multiple coronary plaques than in those with single plaques (28% vs. 12%, p
< 0.04 and 13% vs. 0%, p < 0.008, respectively). Additionally, the carotid
interadventitial diameter was larger in the patients with multiple plaques
than in those with single plaques (7.93 +/-0.97 mm vs. 7.48 +/-0.88 mm, p <
0.01), and a significant correlation was observed between the carotid IMT
and interadventitial diameter (R = 0.54, p < 0.0001). CONCLUSIONS: In ACS,
multiple complex coronary plaques are associated with positive carotid
remodeling, suggesting that plaque vulnerability may be a systemic
phenomenon.

Quoted message said:

Quoted message said:

hsCRP has proven clinical utility, although not as well validated as
CIMT.

Not for assessing coronary plaque stability.

Quoted message said:

MPO has possible clinical utility, although not as well validated as
hsCRP.

From the recent NEJM article from Cleveland Clinic, it now has proven
utility
in assessing stability of coronary plaque(s) that are causing chest pain
in the
acute ER setting.

Quoted message said:

CIMT has not been proven capable of assesing stability of coronary
plaque.

Glad you agree.

not the way you are debating it.

Quoted message said:

Quoted message said:

Coronary angiography is not capable of assesing the stability of
coronary
plaque either.

Correct.

Quoted message said:

IVUS of the coronary arteries, using a radial catheter probe
at lesser axial and lateral resolution than CIMT (lower frequency) is
capable of assessing coronary plaque morphology and as you know is
evolving
into a good tool to guide angioplasty and stent placement.

And IVUS information of plaque lipid content does assess coronary plaque
stability.

when you state this, you are actually supporting CIMT as a method for
assesing coronary plaque stability because, as you know, atherosclerosis is
a global process. However, neither CIMT nor Intravascular ultrasound (IVUS)
has been proven to asses coronary plaque stability.

Quoted message said:

Quoted message said:

CIMT can asses
carotid plaque morphology if performed with high resolution external
10Mhz
linear array probes or better, although you will find conflicting
reports
in the literature as to the reliability of predicting hard clinical
events
with interpretation of carotid plaque morphology.

Imho, you are looking at the wrong part of the body with CIMT.

You cannot interpret CIMT as you have been trained to interpret coronary
angiography. They look at the atherosclerotic process in completely
different criteria.
~~~
Patrick Blanchard, M.D., A.B.F.P.
Board Certified in Family Practice

MD/PhD said:

Dr Chaos said:

Dr. Andrew B. Chung said:

Imho, you are looking at the wrong part of the body with CIMT.

If the biochemical process is similar everywhere and there is
mechanistic correlation between states likely to cause carotid disease
as coronary disease, it should be a good proxy for increased risk
probability.

Ime, the CIMT information contributes very little additively to the CAD
risk assessment ascertainable from a good history, physical exam, EKG,
and
basic blood work including serum glucose and a lipid profile.

Quoted message said:

Not actual disease of course.

Of course.

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

you are wrong on both counts. here are 2 of hundreds of articles you will
find at www.pubmed.gov on carotid intima and global atherosclerosis, and
its use to identify atherosclerotic burden in people wanting to avoid heart
attack and stroke, among other vascular problems. Yes, it is complex, and
cannot be simplified to 5 words in one sentence.

Sramek A, Bosch JG, Reiber JH, Van Oostayen JA, Rosendaal FR.

Ultrasound assessment of atherosclerotic vessel wall changes:
reproducibility of intima-media thickness measurements in carotid and
femoral arteries.
Invest Radiol. 2000 Dec;35(12):699-706.

CONCLUSIONS: Ultrasonography is a reliable and accurate technique to
determine intima-media thickness in superficial arteries. In studies in
which the intima-media thickness determination is used as a marker for
generalized and coronary atherosclerosis, the common carotid artery should
always be included, whereas the benefit of inclusion of other arteries
depends on age and the expected extent of atherosclerosis in the
individuals studied.

Atherosclerosis. 2003 Sep;170(1):181-5.
Impaired insulin sensitivity is an independent predictor of common
carotid intima-media thickness in a population sample of elderly men.

Wohlin M, Sundstrom J, Arnlov J, Andren B, Zethelius B, Lind L.

Department of Public Health and Caring Sciences, Uppsala University,
Uppsala, Sweden. [email hidden]

Most previous studies of associations between insulin sensitivity and
common carotid artery (CCA) atherosclerosis have been conducted in small
samples, have not used direct measurement of insulin sensitivity, and have
yielded inconclusive results. We investigated associations of CCA intima-
media thickness (IMT) and diameter (CCA-D) measured by B-mode ultrasound
and insulin sensitivity measured by the euglycemic hyperinsulinemic clamp
test together with risk factors of the insulin resistance syndrome in a
community-based sample of 493 elderly men. The clamp glucose disposal rate
was an independent predictor of CCA-IMT in multivariate models adjusting
for blood pressure, smoking, serum cholesterol, and body mass index (1%
decrease in CCA-IMT for a 1 unit increase in glucose disposal rate,
P=0.009). Glucose disposal rate was significantly related to CCA-D in
univariate (r=-0.11, P=0.02) but not in multivariate models. In conclusion,
this study is the first to establish impaired insulin sensitivity, measured
by the euglycemic hyperinsulinemic clamp test, as an independent predictor
of CCA-IMT in a population-based sample of elderly men.

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

Dr Chaos said:

Dr. Andrew B. Chung said:

Imho, you are looking at the wrong part of the body with CIMT.

If the biochemical process is similar everywhere and there is
mechanistic correlation between states likely to cause carotid disease
as coronary disease, it should be a good proxy for increased risk
probability. Not actual disease of course.

Firstly, CIMT measures the actual disease process of atherosclerosis, and
has been so very well validated by hundreds of studies.
Go to www.pubmed.gov and search for carotid intima atherosclerosis to get
started.

And yes, it is similar everywhere with the exception that the arterial beds
in the "arterioles" and the "capillaries" and the "veins" are not
influenced in the same way as "arteries". Here is an example of the
vascular system:

Heart>arteries (aorta, arms, legs, brain, heart, kidneys,
etc...>arterioles>capillaries>veins>heart

I also addressed this issue even futher in Dr. Chung's response to your
question.

You are on the right course of thought!

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