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.
After reviewing
these large randomized cholesterol-lowering trials, The National Cholesterol
Education Program (NCEP) expert panel published their new recommendations. The
new NCEP recommendations, presented in the June, 2004 issue of Circulation, are:
The report advised physicians to consider more
intensive LDL cholesterol-lowering for people at very high, high, and
moderately high risk for a heart attack. These options include setting lower
treatment goals for LDL cholesterol and initiating cholesterol-lowering drug
therapy at lower LDL thresholds, as compared to ATP III guidelines published
in 2001. For example, for patients with a very high risk of heart attacks, the
LDL cholesterol treatment goal remains at <100mg/dl, but the report advised
doctors to consider the option of lowering the LDL cholesterol (usually using
a statin plus lifestyle changes) to < 70 mg/dl.
The report emphasized the importance of
initiating therapeutic lifestyle changes (TLC) to modify lifestyle-related risk
factors (obesity,
physical inactivity, metabolic syndrome, high blood triglyceride levels and
low HDL cholesterol levels). TLC Lifestyle changes have the potential to
reduce heart attack and stroke risks through several mechanisms beyond the
lowering of LDL cholesterol.
When LDL-lowering medication is used for very high,
high or moderately high risk patients, the report advises that the intensity
of LDL-lowering drug therapy be sufficient to achieve at least a 30 to 40
percent reduction in LDL cholesterol levels.
When a very high or high risk patient also has high
blood triglyceride or low HDL cholesterol levels, doctors may consider
combining nicotinic acid or a fibrate with a statin. Nicotinic acid and
fibrates are more effective than statins in lowering triglycerides and
increasing HDL.
Age should not be a consideration since
older persons also benefit from lowering LDL cholesterol. Thust, it is never too
late or the patient too old to begin lifestyle changes and medications to lower
LDL cholesterol. A word of caution is in order. Elderly patients are more likely
to have liver and kidney dysfunction, and are also more likely to be on multiple
medications some of which may interfere with the breakdown of
cholesterol-lowering drugs such as statins. Thus lower dosing may be necessary
to avoid adverse side effects.
The 2004 NCEP treatment goals according
to risk categories
Risk category
LDL goal
More intense LDL goal option
Initiate TLC if LDL is:
Consider drugs + TLC if LDL is:
High risk
< 100 mg/dl
> 100 mg/dl
>100 mg/dl
Very high risk
< 100 mg/dl
< 70 mg/dl
> 100 mg/dl
<100 mg/dl
Moderately high risk (10 yr. risk 10-20%)
<130 mg/dl
<100 mg/dl
> 130 mg/dl
>130mg/dl, consider
drug option if LDL is 100-129 mg/dl
Moderate risk (10 yr. risk <10%)
<130 mg/dl
> 130 mg/dl
>160 mg/dl
Lower risk
<160 mg/dl
> 160 mg/dl
>190 mg/dl, consider
drug optional if LDL is 160-189 mg/dl
High risk patients are those who already
have coronary heart disease (such as a prior heart attack), diabetes mellitus,
abdominal aortic aneurysm, or
those who already have atherosclerosis of the arteries to the brain and
extremities (such as patients with strokes, TIA's (mini-strokes), and
peripheral vascular diseases). High risk patients also include those with 2 or
more risk factors (e.g., smoking, hypertension, or a family history of early
heart attacks) that places them at a greater than 20 percent chance of having
a heart attack within 10 years. (A person's chance of having a heart attack
can be calculated by using the Framingham Heart Study Score Sheets, at
http://nhlbi.nih.gov/about/framingham/riskabs.htm).
Very
high -risk patients
are those who have coronary heart disease in addition to having either
multiple risk factors (especially diabetes), or severe and poorly controlled
risk factors (such as continued smoking), or metabolic syndrome (a
constellation of risk factors associated with obesity, including high
triglycerides and low HDL). Patients hospitalized for acute coronary syndromes
are also at very high risk.
Moderately high risk
patients are those who have neither coronary heart disease nor diabetes
mellitus, but have multiple (2 or more) risk factors for coronary heart
disease that put them at a 10 to 20 percent risk of heart attack within 10
years. (Use the Framingham Heart Study Score Sheets, at
http://nhlbi.nih.gov/about/framingham/riskabs,htm to calculate the 10 year
risk.)
Moderate risk patients
are those who have neither CHD nor diabetes mellitus, but have 2 or more risk
factors for coronary heart disease that put them at a <10% risk of heart
attack within 10 years.
Lower risk
patients are those with 0 to 1 risk factor for coronary heart disease.
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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