Heart disease is the number one killer of Americans today. At Lahey Hospital & Medical Center, preventing heart problems from occurring – and diagnosing and treating them at the earliest stage possible – is foremost in our thinking.
Our Cardiovascular Medicine specialists work with physicians from many other medical specialties to ensure the heart health of all who come to us for care. We guide our patients in making lifestyle adjustments that can significantly lower their chance of heart disease, or help keep a problem from progressing.
Some of the heart disease risk factors that we help our patients control include:
- High blood pressure
- High cholesterol
- High blood sugar
- Lack of exercise
If a cardiac problem occurs, we are also focused on preventing it from happening again in the future. We look at a variety of factors, including family history, current health, lifestyle, and more, to estimate a patient’s risk and to help define a healthy management program.
Our Cardiovascular Medicine experts are committed to general and community cardiology – advancing the heart health of the communities we serve. Many patients are referred to us for second opinions, and other physicians contact us for consultations. We have cared for many of our patients for months or even years.
Some of the cardiology conditions we treat include:
- Coronary artery disease
- Heart failure
- Valvular heart disease
- Unexplained abnormal EKGs
- Abnormal heart tests performed at other institutions
- Abnormal stress test results
- Abnormal coronary angiograms
- And more
For the convenience of patients, we offer our cardiology services at three locations:
In keeping with Lahey’s culture of multidisciplinary collaboration, we read EKGs and stress tests for other Lahey physicians as well as for community providers. Reading an EKG takes special skill and expertise to pick up subtle changes that could indicate a major problem.
- Bruce Mirbach, MD, Vice-Chair, Department of Cardiovascular Medicine
- Sidney Alexander, MD, Chairman Emeritus, Department of Cardiovascular Medicine
- Richard Nesto, MD, Executive Vice President and Chief Medical Officer, Lahey Health
- Maurizio Diaco, MD, Medical Director, Inpatient Cardiology Service
- Timothy Draper, DO, Medical Director, Lahey Peabody Cardiology
- Jeffrey Clayman, MD
- Raphaella Chatelle, PA
PCSK-9 Inhibitors to Treat High Cholesterol
While the powerful benefits of statin therapy in the prevention of CV events are well documented, intolerance to statins is incredibly common and frequently challenges a patient’s ability to achieve adequate reduction of LDL cholesterol levels. In fact, in the U.S. it is estimated that 25% of statin users complain of some level of muscle pain, and fully 8% of patients are unable to tolerate even one statin drug.
In addition, a relatively high number of patients at particularly high risk (such as those with both diabetes and recent acute coronary syndrome) have an inadequate response of LDL lowering to maximal statin therapy.
However, there is now great hope for successfully treating these patients. In 2015, the first two monoclonal antibody injectable PCSK-9 inhibitors were approved for use in the U.S.
These antibodies prevent the liver from reclaiming LDL receptors, thereby maintaining high levels of the receptors, and yielding significant declines in circulating LDL. In the ODYSSEY study (see image below), alirocumab (Praluent) demonstrated a 62% reduction in LDL levels, in addition to maximally tolerated statin therapy, and was associated with a significant reduction in adverse cardiac events including death due to CAD, MI, stroke or unstable angina. Separately, evolocumab (Rapatha) was shown to reduce LDL levels by 50-60% as compared with optimal medical therapies.
At Lahey, we have been prescribing PCSK-9 therapy for our highest risk patients since 2015. Despite the very high cost of these agents, and the many “hoops” the patient (and we) need to jump through in order to gain approval, we have been successful in getting the medications approved in 70% of the patients we have referred for therapy. In our patient population, we have seen a 65% reduction in measured LDL (pre-PCSK9=174 mg/dL and 90 days into treatment LDL=59 mg/dL).