Doctor Zaidi's Blog

 

1- Avandia and Heart Disease Controversy

2- President Clinton's Heart Disease!

 

Avandia and Heart Disease Controversy

Avandia (rosiglitazone) is back in the news!

 According to the New York Times, internal F.D.A. reports say "that if every diabetic now taking Avandia were instead given a similar pill named Actos, about 500 heart attacks and 300 cases of heart failure would be averted every month because Avandia can hurt the heart."

 Since late 2007, there has been controversy about the safety of Avandia, but the F.D.A. has decided to keep the drug on the market.

Back in 1999, when Avandia and Actos were released to treat Type 2 Diabetes, I, like some other endocrinologists, picked Actos over Avandia. Why? Because although the two drugs belong to the same class of drugs, TZD  (Thiazolidinediones), they are different from each other as far as their effect on Triglycerides (lipids) is concerned.

In Type 2 diabetics, there is an increase in the blood level of triglycerides, which is due to insulin resistance at the level of the fat cell. In the vast majority of Type 2 diabetics, insulin resistance is the root cause.

While Actos consistently decreases the level of triglycerides, Avandia has variable effects and can sometimes increase the blood level of triglycerides. For this reason, I decided to choose Actos over Avandia and was not swayed by the intense marketing done by Avandia's manufacturer, GlaxoSmithKline.

As it turns out, this was a good decision. My patients have benefitted from the great effects of Actos and did not suffer from the potential bad side-effects of Avandia.

Over the last ten years of using Actos in thousands of my diabetic patients, I find this drug to be safe and an extraordinary drug in treating Type 2 diabeties.

 

 

President Clinton's Heart Disease!

Former president Bill Clinton is in the news again. On February 11, he had two stents placed in his clogged coronary arteries. Remember, only about 5 years ago, he had undergone quadruple heart bypass surgery.  

Why did he need another procedure for the clogged coronary arteries only a few years after having gone thru major bypass surgery? This happens all too often. Every physician knows that. Isn't it time we look deeper instead of just keep doing damage control by procedure after procedure.


What really causes clogging of the coronary arteries to begin with? Is it simply cholesterol? Then a cholesterol lowering medicine such as statin drug should be able to prevent further clogging of arteries. But does it? Every physician knows that patients on statin drugs continue to require repeated procedures such as stent placements and heart bypass surgery . And you can verify it by sitting in an ER and taking history from those coming with chest pain. Why?

Obviously the solution is not as simple as most people are made to believe.

If you don't identify the real root cause of a problem, you will continue to suffer its consequences.


So what is the root cause of clogging of coronary arteries? In most cases ( especially if you are overweight ) it is Insulin Resistance: a complex process in your body which is responsible not only for the clogging of the arteries but also can lead to prediabetes, diabetes, high blood pressure and cancer.

 
Physicians who are knowledgeable in the field of insulin resistance are Endocrinologists. The irony is people rush to seek help about the clogging of their coronary arteries from cardiologists who do procedures aimed at fixing the consequences, but in general do not treat insulin resistance, the root cause. Therefore, people continue to suffer more and more coronary events. No one ever thinks of consulting an endocrinologist: the only physician who can take care of the root of the problem.

Here's hoping Bill Clinton is soon under the care of a good endocrinologist.

Any one who has a coronary history should consult, in additon to a cardiologist, an endocrinologist for the evaluation and treatment of insulin resistance.


Click here to to learn about Insulin Resistance and Heart Disease  

 

This article was written by Sarfraz Zaidi, MD, FACE. Dr. Zaidi specializes in Diabetes, photoEndocrinology and Metabolism.

Dr. Zaidi is a former assistant Clinical Professor of Medicine at UCLA and Director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California.

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