Niacin: The Real Story (2nd Edition) by Andrew W. Saul

Author:Andrew W. Saul
Format: epub

A Family Story

While I (SM) was learning lipidology in the period between 2002 to 2007, my father suddenly went to the ER late one Sunday night and my mother called me hysterically: “I took your father to the ER and now they are scheduling him for placement of stents.” I was concerned, as any son would be, but also as a scientist because I felt I may have “failed him,” somehow: If only what I had learned, I had learned sooner.

My father was 81 at the time and he had been jumping rope for 30 minutes, twice daily. His body had a deceptively healthy look, and his triglycerides were low, but when we put it all together, he was “Pattern-B”—insulin resistant. He had always been a “stodgy,” stubborn, stoic World War II veteran. He was very introverted and typically had a limited range of emotions: rage, laughter, and silence. Later, I would find out he had Asperger’s.

When I received the advanced laboratory data, it showed that he had low HDL2 and high ApoB. This is far more specific and confers much greater risk vs. an elevated LDL-C. Most importantly, this revealed he was insulin resistant (pre-diabetic). At the time, I really didn’t fully understand this. Even today, most clinicians really do not, due to continued reliance on using only tests for FBG and HbA1c. Ultimately, my father survived that, and we continued to institute aggressive medical management: A hard lesson learned.

My father and my mother traveled everywhere together. They commuted, seasonally to Florida each winter, to escape the cold weather in northwest Pennsylvania. On New Year’s Day, about six months after his myocardial infarction and stent-placement procedure, I received a call from my mother: “Your father is in the hospital! They’re going to have to do open-heart surgery!”

They needed to do an aortic-annuloplasty (aortic heart valve repair) in addition to a quintuple CABG (5 bypass grafts). I thought to myself, “this is getting worse and worse.” Having had previous personal experience working with thoracic surgeons during open-heart operations, I didn’t want the procedure to begin until my brother and I were able to be present. Fortunately, the young thoracic surgeon and the techniques planned were excellent.

Later, in the spring, they returned home to Erie, Pennsylvania, for the follow-up visit. Dr. Dave (the physician who asked me to set-up my first lipid clinic) said, “Hey, I got some bad news for you. Your dad has renal insufficiency.” I said, “Oh my God, he’s in renal failure. What stage is he?” He did not know. That was a flag. Most clinicians don’t know what stage their CKD patients are because the lab doesn’t do calculations and the creatinine measure is not reliable or accurate. The creatinine measure has very little accuracy until after the CKD has “hit” stage 3B, and beyond.¹⁹²,¹⁹³ So, a lot of these patients along the CKD disease continuum, through each progressive stage, appear to have less risk vs. the “true” risk that is present. It’s better to test

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