Current News
Successful bypass surgery has this Norfolk man back on the walking path and looking to a longer, healthier life.
In an effort to help all members of the DCC in their pursuit of optimal health, we have partnered with registered dietitian Judy Metnick, M.J., R.D. and certified personal trainer Reese Edgington with Fitness Together.
Judy will be providing bimonthly seminars on a variety of nutritional and wellness topics. A list and brief description of upcoming seminars are attached for your convenience. Space for each session is limited so contact your PSC for dates and times of each session and reserve your spot today. Seminars will be repeated over the upcoming months to allow ample opportunity for all to benefit.
Fitness Together will be offering one-on-one personal fitness assessments. Your session will begin with a baseline evaluation of your current aerobic fitness level with our microfit bicycle under the supervision of a qualified expert. A one-on-one discussion with our trainer will follow. Recommendations on beginning an exercise program or improving on your current program will be provided. All questions are fair game, so bring your comfortable clothes and get fit! Call your PSC to schedule your individual session today.
Authored by Glenn C. Jones, M.D.,M.B.A.,F.A.C.P. April 2008
There has been quite a bit of concern and confusion since the release of information about the ENHANCE trial on Zetia. We feel it is important to put this study in perspective – particularly since it raises the immediate question of whom, if anyone should use Zetia.
Zocor is a statin like Lipitor and Crestor. Zetia mixed with Zocor is called Vytorin. This combination is hoped to mix two approaches to cholesterol therapy. In simple terms, Zetia works by blocking absorption of bad cholesterol in the intestines and Zocor works by inhibiting a liver enzyme that makes bad cholesterol (LDL). The TV commercial calls this combining “the fettuccini Alfredo” (Zetia) with “the Uncle Alfredo” (Zocor).
ENHANCE is a surrogate endpoint trial conducted in only 720 patients with Heterozygous Familial Hypercholesterolemia (HeFH), a rare condition that affects approximately 0.2% of the population (2 people in one thousand). A “surrogate endpoint” does not directly measure hard outcomes like reduction of chance to die, to have a heart attach, or to have a stroke. For example, a “surrogate endpoint” is one that might be associated with reduction in risk of death or heart attacks. Bad cholesterol (LDL) in heart patients and hemoglobin A1C in diabetic patients are examples of surrogate markers.
The primary endpoint in the ENHANCE study was the mean change in the intima-media thickness (IMT) measured at three sites in the carotid arteries between patients treated with Zetia and Zocor versus patients treated with Zocor alone for a two year period. Thus, the study was designed to measure the inner lining of the carotid arteries.
There was no difference between treatment groups on the primary endpoint – thickening of the carotid arteries. The change from baseline in the mean carotid IMT was 0.011mm for the Zetia/Zocor group versus 0.006mm for the Zocor only group, which was not statistically significant. Realizing that a millimeter (mm) is less than 1/25 of an inch, this represents an incredibly small difference, whichever way the results may have come out.
The overall rates of treatment-related serious side effects or side effects leading to stopping the medicines were very low and similar between both treatment groups. Both medicines were well tolerated. Overall, the safety profiles of Zetia/Zocor and Zocor alone were very good. Specifically, no serious liver or muscle problems developed with either group.
There was a significant difference in “bad” cholesterol “LDL” lowering seen between treatment groups – 58% LDL cholesterol lowering on Zetia/Zocor as compared to 41% on Zocor alone. Lowering LDL cholesterol has been shown to lower the risk of death, heart attack, and stroke in previous outcome trials.
Three large outcomes trials with Zetia/Zocor (Vytorin), which involve more than 20,000 high-risk patients, are currently in progress. The completion of these studies will be late 2009 and early 2010. The results will establish whether adding Zetia to a statin drug like Zocor or Lipitor will benefit patients more than just lowering their bad cholesterol about 20% more than statin therapy alone.
In summary, the results of the ENHANCE trial show no benefit from the combination of Zetia and Zocor (sold together as Vytorin) over Zocor alone in terms of affecting the rate of thickening in the carotid arteries. The study involved only 720 patients with heterozygous familial hypercholesterolemia – a group of patients with extremely high cholesterol at levels of 600 and above. Thus, it is not reasonable to assume these results apply to most of the population.
The American College of Cardiology (ACC) recommends that major clinical decisions not be made on the basis of the ENHANCE study alone. This study does deserve careful thought and follow-up. The overall incidence rates of heart attacks and strokes were very low and nearly identical between both treatment groups. Both medicines were well tolerated. The difference in carotid artery lining changes between the Zocor group and the Zetia/Zocor group was 0.006mm versus 0.011mm. This represents 5/1000 of a millimeter (mm). Remembering that a millimeter (mm) is less than 1/25 of an inch, this difference is meaningless.
Further, the ACC notes that this trial is an imaging study and not a clinical-outcome study. Final conclusions cannot be made until the three large clinical-outcome trials on Zetia are presented within the next two or three years. The ACC recommends that Zetia remain a reasonable option for patients who are currently on a high dose statin but have not reached their goal for reducing bad cholesterol (LDL). Zetia is also a reasonable option for patients who cannot tolerate statins or can only tolerate a low dose of stating therapy.
If you have any questions concerning Zetia given the above, please feel free to contact your Dedicated Care Center physician. We want you to continue your current medication regimen, including Zetia/Vytorin, until we can talk about it on your next visit.
Dr. Glenn Jones was named the 2008 Virginia Young Internist of the Year by the American College of Physicians, the academic and professional association for Internal Medicine physicians. The award was decided by the Virginia chapter’s Awards Committee, which includes a past president of the American College of Physicians, the current Governor of the Virginia chapter and the Director of Medical Services at the National Naval Medical Center. Five letters of support were required and were submitted by physicians from around the state, including one from his DCC colleague Dr. Charles Lisner. The award is designed to recognize excellence in leadership within the profession, academics, medical research, teaching and mentoring, and volunteerism. Dr. Jones is Chair of the 2008 Virginia ACP Annual Scientific Meeting being held in Williamsburg, and chairs several committees on the Governor’s Council. He served as Chairman of Medicine at Danville Regional Medical Center and volunteered as an attending physician at the Danville Free Clinic before he joined the Dedicated Care Center in July 2007. He has been a principal investigator or sub-investigator on over 40 pharmaceutical clinical trials involving diabetes, heart disease, inflammatory bowel diseases and emphysema. He has taught medical students since 2003 in his role as Visiting Assistant Professor of Medicine at the University of Virginia. He will receive his award at the Virginia ACP’s annual meeting in March.
The Dedicated Care Center is excited to announce our latest efforts to reinforce our commitment to service and efficiency by opening an on-site dispensary of prescription medications. We are currently stocked with over 100 medications and are credentialed with most major insurance carriers. If you need a prescription filled and don’t want the hassle of waiting at your local drug store chain, please stop in and see us! Holly, our licensed Pharmacy Technician will ask you for your insurance and prescription card(s) and fill your prescription in a matter of minutes! For more details, please consult your Patient Service Coordinator. As always, we are committed to exceeding your expectations and thank you for your on-going trust and confidence.
Dr. Jones graduated from high school in England where he won an academic scholarship to Eton, and then earned a Bachelor of Arts and Science degree from Stanford University in 1991. He went on to study at the Ecole Nationale des Ponts et Chaussées in Paris, and received his MBA in International Business in 1993. His medical degree is from the University of Chicago and he completed his internship and residency at Duke University Medical Center in 2001. He was certified by the American Board of Internal Medicine in 2002.
To schedule an appointment with Dr. Jones, please call (757) 388-1852.
Please join us in congratulating Dr. Bethea on setting sail toward some much needed rest and relaxation! Dr. Bethea has decided to take a leave of absence and we are looking forward to seeing him back to work at the Dedicated Care Center. If you are a patient of Dr. Bethea’s, please continue to call 757-388-1851 and a Patient Services Coordinator will be happy to direct your care to one of our other Dedicated Care Physicians.