Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Ezetimibe lowers blood cholesterol by blocking the absorption of cholesterol,
including dietary cholesterol, from the intestines. It does not affect, however,
the absorption of triglycerides or fat-soluble vitamins. Ezetimibe was approved
by the FDA in October, 2002.
Ezetimibe can be used alone or together with a
statin drug. Ezetimibe used alone is modestly effective in lowering LDL
cholesterol. At a dose of 10 mg/day it can reduce LDL cholesterol by
approximately 17%. When used with a statin, it can reduce LDL cholesterol level
further than a statin alone. However, there is insufficient scientific data to
determine whether a statin-ezetmibe combination actually further reduces heart
attack or stroke risks. A new combiniation drug, Vytorin, is available and
combines 10 mg of Zetia with 20, 40, or 80 mg of Zocor.
Ezetimibe is probably
most useful in avoiding having to use high doses of a statin to achieve the 2004
NCEP LDL cholesterol targets in certain patients. Using lower doses of a statin
probably reduces the risk of muscle injury. A statin-ezetmibe combination may
also be helpful in treating patients with very high LDL cholesterol who cannot
attain LDL cholesterol targets even with maximal doses of statins. Ezetimibe can
be taken with or without food and at the same time as statin drugs.
Ezetimibe is
well-tolerated. The overall rate of side effects with ezetimibe in clinical
studies was similar to that reported with a placebo (an inactive sugar pill).
Diarrhea, abdominal pain, back pain, joint pain, and sinusitis were the most
commonly reported side effects, occurring in 1 in every 25 to 30 patients.
Unfortunately, the prevention and treatment of atherosclerosis are more
complicated than just lowering LDL cholesterol levels. LDL cholesterol reduction
is only half of the battle against atherosclerosis. Individuals who have normal
or only mildly elevated LDL cholesterol levels can still develop atherosclerosis
and heart attacks even in the absence of other risk factors such as cigarette
smoking, high blood pressure, and diabetes mellitus. Additionally, successfully
lowering elevated LDL cholesterol levels cannot always prevent atherosclerosis
and heart attacks. In many clinical trials to lower LDL cholesterol, there were
patients who adhered to their assigned diets, faithfully took their
cholesterol-lowering medications, and successfully lowered their LDL cholesterol
to target levels, yet still suffered progressive atherosclerosis and heart
attacks. It is clear that while lowering LDL cholesterol below NCEP target
levels is an important step, there are other factors involved.
In addition to low HDL levels, diabetes, hypertension, cigarette smoking, and
a family history of coronary heart disease, the other risk factors are small LDL
particle size, elevated Lp(a) cholesterol, and elevated homocysteine.
Angina is chest pain that is due to an inadequate supply of oxygen to the heart muscle.
Angina can be caused by coronary artery disease or spasm of the coronary
arteries. EKG, exercise treadmill, stress echocardiography, stress thallium, and cardiac
catheterization are important tests used in the diagnosis of angina.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
Rhabdomyolysis is a rapid deterioration and destruction of skeletal muscle. Some of the causes of rhabdomyolysis include severe burns, muscle trauma, coma, seizures, electrolyte imbalance, medications (statins), viruses, bacteria. Treatment of rhabdomyolysis depends on the cause.
Peripheral vascular disease (PVD) refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain. While there are many causes of peripheral vascular disease, doctors commonly use the term peripheral vascular disease to refer to peripheral artery disease (peripheral arterial disease, PAD), a condition that develops when the arteries that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis. Peripheral artery disease symptoms include: intermittent claudication, rest pain, numbness in the extremities, and more. Treatment for peripheral artery disease include: lifestyle measures, medication, angioplasty, and surgery.
When a portion of the brain loses blood supply, through a blood clot or embolus, a transient ischemic attack (TIA, mini-stroke) may occur. If the symptoms do not resolve, a stroke most likely has occurred. Symptoms of TIA include: confusion, weakness, lethargy, and loss of function to one side of the body. Risk factors for TIA include vascular disease, smoking, high blood pressure, high cholesterol, and diabetes. Treatment depends upon the severity of the TIA, and whether it resolves.
Heart attacks are the major causes of unexpected, sudden death among men and women. A heart attack is also a significant cause of heart failure. Learn the risk factors for heart attack such as high blood pressure, diabetes, and other heart conditions. Lowering your risk factor, lifestyle changes, and in some cases medication are the most effective way of preventing a heart attack.
A heart attack is a layperson's term for a sudden blockage of a coronary artery. This photo essay inlcudes graphics, pictures, and illustrations of diseased heart tissue and the mechanisms that lead to coronary artery disease, and possible heart attack.
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