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.
Nicotinic acid (niacin) is a B vitamin. An average American diet contains
15-30 mg of niacin per day. However, in treating blood cholesterol and
triglyceride disorders, high doses (1-3 grams a day) of nicotinic acid are
necessary. Nicotinic acid is available in several preparations that include
immediate release niacin, sustained release prescription brand Niaspan, and
over- the- counter (OTC) sustained release niacin. OTC preparations are not
federally regulated, and some OTC preparations may have no active ingredient.
Thus, they would be ineffective in either lowering LDL or raising HDL
cholesterol. Some formulations of OTC sustained release niacin have been
associated with liver toxicity and rare cases of fulminant (usually fatal
without liver transplantation) hepatitis have been reported. The prescription
brand sustained release Niaspan has been found in clinical trials to cause only
minor elevations in blood liver enzymes without causing significant liver
disease.
Nicotinic acid is most effective in increasing HDL cholesterol and it is also
modestly effective in lowering LDL cholesterol, Lp(a) cholesterol, and
triglyceride levels (see below). Nicotinic acid is most suited for individuals
whose only problem is low HDL cholesterol. Nicotinic acid used alone can raise
HDL cholesterol levels by 30% or more. Nicotinic acid is not as effective as a
statin in lowering LDL cholesterol levels. Therefore, when low HDL cholesterol
is accompanied by high LDL cholesterol, most doctors use a statin to decrease
the LDL cholesterol first. If necessary, nicotinic acid can be added to a statin
to further raise HDL cholesterol levels.
Advicor is a combination product approved for use in the United States. It is
a combination of sustained release niacin with lovastatin. Advicor is useful in
patients who need to both significantly lower their LDL cholesterol and increase
HDL cholesterol.
What are the side effects of niacin?
The most common side effect of nicotinic acid is a flushing (which can occur
in 80% of patients taking the immediate release crystalline preparations),
itching, and upset stomach. Other side effects include liver toxicity,
aggravating blood sugar levels in patients with diabetes mellitus, and
precipitating painful arthritis attacks in patients with gout.
The itching, flushing, and stomach upset can be partially alleviated by the
following measures:
Taking nicotinic acid with meals.
The sustained release Niaspan capsules release
nicotinic acid from the stomach into the blood circulation more gradually than
the immediate release preparations. Therefore, Niaspan produces a lower
incidence of upset stomach and skin flushing than the niacin immediate release
tablets.
Pretreatment with aspirin 30 minutes prior to
nicotinic acid can reduce flushing.
Initiating nicotinic acid treatment at low doses and
gradually increasing to the targeted dosage.
Liver toxicity with the immediate release nicotinic acid is usually mild and
in the form of abnormal elevation of liver enzymes in the blood, which
normalizes when nicotinic acid is stopped. Severe liver diseases, including
fulminant hepatitis (see above), have been reported, especially with the use of
over-the-counter sustained release formulations. The onset of liver damage with
nicotinic acid is unpredictable. Therefore, patients taking any nicotinic acid
preparations should have regular liver enzyme blood tests.
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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