What’s in your wallet?

DR. DAVEMy wallet is the happy home to a torn $5 bill, lint, my Drivers License with a photo that would terrify small children and most pterodactyls, a ticket stub for Monster Truck Rally, a photo of Raminator - the bestest truck of all, Donna Summers Fan Club membership, plastic, a receipt for a Raminator T-shirt and in a wee clear packet, tucked away near the lint, I keep some pills. Emergency pills just in case I happen upon a heart attack or a stroke, mine included. What is in that packet is a trade secret but I will reveal, that, of the three emergency pills I carry at all times, one of them is a “statin.” (To know what the other two are you must either send me $1,349 + tax or go to

By now most of you know of statins, commonly referred to in playgrounds as “3-hydroxy-3 methylglutaryl-coenzyme A reductase inhibitors.” But I will heretofore refer to them as statins, if you don’t mind. Should, one day, you be wheeled into the ER, in the throes of the common yet deadly heart attack or stroke, you will be given a statin immediately upon your arrival unless you happen to have been in my hockey rink and I happened to have remembered my wallet. 

There are those who feel that statins should be in the water. They are just that helpful with dealing with these two very common killers. 

But not always.

As doctors we love to see you get high. We also love to see dense patients as we strive to be dense doctors, some denser than others, eh? 

HDL-High Density Lipoprotein is a good... no it’s a GREAT cholesterol. It reverses cholesterol transport and gobbles and scavenges up the foamy cholesterol that lurks about your blood system hoping to form plaques that leads to clots that leads to trouble that lead to me opening my wallet and digging through the lint. HDL is the anti-Crisco. Those of you with naturally high levels of HDL (thanks to your genes) are fortunate.  

LDL- We despise the deadly Low Density Lipoprotein, the bad cholesterol. This is the main target of a statin. This is the anti-Christmas reunion. Those of you with high levels of LDL are unfortunate.  

While statins can help knock down LDL, they don’t do much for HDL. For decades, medicine has searched for a way to help us elevate our HDL. Well.... 

In fact, wouldn’t it be great if there was a medication that could elevate HDL and lower LDL all at once! Well... 

Well, you read it here first folks. Finally there is!! Every so often a medication comes along that has the potential to change medicine and our lives for the better.

There are some journals that always catch a doctor’s attention. Anything with the word New England or Lancet on it means serious business. Anything with Teen Tiger on it means serious problems. 

December 16, 2010 edition of the New England journal reported on the results of use of a medication called anacetrapib. It astounded researchers by lowering LDL by 40 percent while raising HDL by a stunning 138 percent! It had a superb safety profile and  
those in the study, on anacetrapib, had significantly lower cardiovascular events than the others. A medical event is not a good thing like a Monster Truck event. Medical events include heart attacks, strokes or your canoe flipping over while you’re navigating rapids that you were unaware of were ahead of you as your buddy, Roy, who sat in the bow forgot to warn you that the river you were about to canoe was a Class 3 river. But this is so New England Journal-excitable that large international studies are being conducted now. In fact, the only way you can get anacetrapib is if you’re chosen for a study. Go take care of your cholesterols. Don't be dense, go get dense.

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