WITHOUT THE WHITECOAT
By Dr. Florentino Alerta

PFIZER's CARDS… effective at 10 mg

 The CARDS trial that was presented in Cebu last March 10, 2005 said it all… safe and effective at 10 mg dose, because it had shown to reduce the first cardiovascular disease events like stroke in patients with Diabetes Mellitus 2 without high LDL-cholesterol levels.

The lecture by Dr. Ricardo Fernando was an eye opener for all of us, showing the role of statins for the primary prevention of cardiovascular disease in diabetes is adequately defined. It was further reiterated by the “father” of diabetes in the Philippines the effectiveness of a 10 mg statin ( Atorvastatin )   for the primary prevention of major cardiovascular events in patients with type 2 diabetes without high concentrations of LDL-cholesterol.

Syndrome X was again pinpointed to the development of complications in patients. The syndrome comprises a list of the disease entity like Diabetes Mellitus, Hypertension, Hyperlipidemia , Obesity and lastly Smoking. The early detection of Diabetes is seen in the early rising of the blood insulin levels, irregardless of the sugar level. ( thus it was found out that blood insulin assay is the most accurate diagnostic tool in the diagnosis of diabetes mellitus in its early stage, he showed that the OGTT is an obsolete measure for sugar levels). It was not just on central obesity, but on the presence of fat in the abdominal cavity which is dangerous and predisposes the individual to artherosclerosis . Diabetes was great touch due to the effects of statins and also the effects of statins on syndrome X. Shown were slides of foam cells which were found on ages 2 and 3 years old and with combinations of free radicals will eventually lead to cell death. It was shown that 75% of coronary artery disease will be secondary to plague formation and fibrosis.

The Collaborative Atorvastatin Diabetes Study (CARDS) was shown to be safe and effective. It was 2 years early that the study had to be stopped due to a highly significant reduction in cardiovascular events compared to its placebo counterpart. The first in its class of statins to show its effects on diabetic patients. There was a reduction of 37% in major cardiovascular disease events and stroke was reduced to 48%.

There is always that fear of an impending liver disease due to the use of statins. The study had shown that atorvastatin was safe and well-tolerated. There were no cases of rhabdomyolysis in patients on atorvastatin and no difference in muscle symptoms between the intervention group .

The lecture of Dr. Fernando had shown that resistance was due to the presence of macrophages. The increasing risk factors and complications seen in syndrome X are attributed to the triad of increase triglyceride levels, decreased HDL (good cholesterol) levels with increasing LDL (bad cholesterol) levels, and a high levels of apo C III (increased superoxides , decreased nitrous oxide which predisposes to vasodilatation then it leads to ischemia.

Changing the ongoing lifestyle that we all have in which in our stage of life we are all dependent on fast food chains for our daily meals not knowing that it is the number one culprit in what we call dysmetabolic disease which will later lead us to the new disease of our generation “ disease of lifestyle”-- fast food meals and we will see that diabetes mellitus is a disease of hypercoagulable state with myocardial infarction.

Remember “AGE” and “ STRESS ” plays an important role that directs our lives to artherosclerosis and we as your doctors can surely address this issue. Dial or hook up with your friendly Filipino Family Physician near you or at www.pafp.net or contact your local Philippine Academy of Family Physician Iloilo City Chapter at drpatchadamsilo@yahoo.com.