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Sandeep Chandra, MD FACC is board certified in Cardiovascular Diseases along with Internal Medicine and Nuclear Cardiology. He is an Asst. Clinical Professor of medicine at Emory University Hospital. He received his medical degree in Tennessee and received his training in Cardiology at Brown University in Rhode Island. His practice is currently located in Tucker/Norcross & Alpharetta, GA.
Email , Phone 770-638-1400
Prescription for Controversy

Vioxx, Statins, herbal supplements… medical issues that hit the headlines in the past year. DR SANDEEP CHANDRA explains what the furor was all about.

As we enter the New Year 2005, it is interesting to reflect on the major medical news of the year 2004. Certainly, medical news does not claim the hottest time slots or venues in popular media, but clearly invokes the interest of the majority interested in experiencing potential longevity in a healthy style.

Clearly, many medical issues have surfaced in the year 2004. This article will focus on a few which may be of general interest. 

Most notable in the news was the implication of Vioxx in increasing the risk of cardiovascular events. This was very troubling particularly in light of how widespread the use of this particular medication was. FDA review subsequently removed Vioxx from the market. I have personally heard from many patients whose lives had improved dramatically from Vioxx and reluctantly had to give up its use or face possible cardiac events. Since then, two other popular drugs, Celebrex and Bextra are being reviewed. It has been discovered that Celebrex may cause a problem at higher doses but has been proven to be safe at the conventional lower doses. However, Celebrex will have a hearing in with FDA on February 17th, 2005. Preliminary data shows that they will remain on the market at lower doses. However FDA recommendations are pending. In any case, anyone who is currently on Celebrex, should contact their physicians to seek their opinions.

Prior to the Cox-2 inhibitors (Celebrex, Vioxx and Bextra) hitting the news, there were plenty of reports about the adverse effects of Statins. This class of medication has been used primarily to lower cholesterol with a subsequent secondary benefit of reduced risk of stroke, heart attacks and various blockages in the arteries supplying the various parts of the body. Based on five major scientific studies in the United States, there was compelling evidence that highlighted the protective benefits of these drugs. These led the guidelines to be revised and decreased the tolerance for high cholesterol. For patients at high risk for heart disease, the recommendations called for reduction of LDL (Bad Cholestrol) to below 70 from previous recommendations of 100. For patients at low to moderate risk of heart disease, guidelines called for LDL to be below 100 as opposed to 129 in the past. There has also been new understanding that high levels of good cholesterol (HDL) may be more protective than low levels of bad cholesterol. Despite all the good that came of the statins, there was increased awareness of the risk of these medications as well. Particularly with Crestor being in the media, it is well accepted that these medications can have serious side effects, although the risk is much lower than the benefit in the carefully selected cases. With close monitoring, risk of toxicity can be limited.

In the midst of increasing awareness of potential risks with allopathic medications, there has been a marked increase in the use of natural medications also referred to as herbal supplements. As they are not subjected to the careful scrutiny of FDA, they can make claims that have been poorly substantiated. Clearly, there are many supplements that have beneficial effects. There are many with toxic effects. There is a popular belief that supplements are inherently safe. This should be interpreted with caution, as the toxic effects may not have been studied. A short list of supplements to avoid includes aristocholic acid, comfrey, androstenedione, chaparral, germander, kava, bitter orange, organ or gland extracts, lobelia, pennyroyal oil, skullcap and Yohimbe. In addition, FDA has advised consumers to steer clear of supplements called Actra-Rx and Yilishen as they contain prescription strength levels of sildenafil, the active ingredient in Viagra. This can interact with some heart medications and cause low blood pressure. Researchers at the Univesity of Chicago found that ginseng, widely used to boost energy can do some harm. It can interact with heart medications such as coumadin which can be life threatening. 

What is absolutely clear as we enter the year 2005 is that although medications and supplements can do a lot of good, they need to be viewed with caution and taken carefully under the guidance of your physician. Clearly nothing can be better than use of better lifestyle habits wherever that option exists. One can practice prevention and experience optimal health by practicing moderation in consumption, diligence in exercising and managing stress optimally. Wishing everyone best of health for the year 2005.

*Disclaimer: The contents are meant for informative, educational purposes only. Formal recommendations can only be made by physicians involved in your care. Please check with your physician before acting on any part of this article.