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.
Fibric acid derivatives (fibrates) are effective medications in lowering blood
triglyceride levels. Fibrates lower blood triglyceride levels by inhibiting the
liver production of VLDL (the triglyceride-rich lip-protein fraction), and by
speeding up the removal of triglycerides from the blood. Fibrates are also
modestly effective in increasing blood HDL cholesterol levels. However, fibrates
are not effective in lowering LDL cholesterol. Examples of fibrates available in
the United Sates include Gemfibrozil (Lopid) and fenofibrate (Tricor).
Very high triglyceride levels (usually > 1000 mg/dl) can cause pancreatitis
(inflammation of the pancreas that can result in a serious an illness with
severe abdominal pain). By lowering the blood triglycerdes, fibrates are used to
prevent pancreatitis.
Fibrates are not effective in lowering LDL cholesterol and cannot be used
alone in lowering LDL cholesterol levels. However, when a high risk patient (see
NCEP recommendations above) also has high blood triglyceride or low HDL
cholesterol levels, doctors may consider combining a fibrate, such as
fenofibrate (Tricor), with a statin. Such a combination will not only lower the
LDL cholesterol, but will also lower blood triglycerides and increase HDL
cholesterol levels.
Fibrates have also been used alone to prevent heart attacks especially in
patients with elevated blood triglycerides and low HDL cholesterol levels. In
one large study, gemfibrozil decreased the risk of heart attacks but did not
affect the overall survival of persons with high cholesterol levels.
What are the side effects of fibrates?
The side effects of fibrates include nausea, stomach upset, and sometimes
diarrhea. Fibrates can also cause liver irritation. The liver irritation is
usually mild and reversible, but it occasionally can be severe enough to require
stopping the drug.
Fibrates can cause gallstones when used over several years.
The fibrates can increase the effectiveness of blood thinners, such as
Coumadin, when both medications are used together. Thus, the dose of Coumadin
should be adjusted to avoid over-thinning of the blood, which can lead to
excessive bleeding.
Fibrates can cause muscle damage. Doctors generally avoid combining a statin
with gemfibrozil because of concern over the added risk of muscle damage with
the combination. Gemfibrozl interferes with the breakdown of statin, resulting
in higher statin blood levels, and hence a higher likelihood of muscle toxicity.
Fenofibrate does not interfere with the breakdown of a statin, and should be the
safer fibrate to use whenever a fibrate-statin combination is necessary.
Furthermore, pravastatin seems to have fewer muscle toxic effects than the other
statins when combined with a fibrate.
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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