Drs. Cork, Gonzalez and Triffon answer questions from course participants.
So we're now going to pivot to our Q. And a. We went a little bit over on our time. We do need to take a break around 9:55. So I just got a little bit of time. I just want to make sure that all the presenters are here and ready to go and then I'm gonna pull up our questions. Uh there we go. Okay, so I think we're good. Um so let me just go to the question page here. One second. Okay, first. Uh so I have some questions for all of you. If we have enough time. First one was for dr Trip in um it was uh again, a lot of comments on how great the talk was. You reviewed a number of myths that myths that debunks some of our traditional management strategies. This included some new biomarkers and the fact that our current risk calculators are likely not that accurate. So dr trip, and the question is how do we put it all together? You know I mean there was a lot there in your talk again. I would have loved to give you more time. But um you reviewed a number of these different biomarkers and your challenges. Risk calculator. So is there some kind of way you can guide the viewers on like how you put it all together? So then the question is now that you've got me massively confused, what do I do? And so again we look to the Europeans because they're more advanced and they use something called computers that we tend not to use to put this all together. So there's a wonderful website the two academic cardiologist in your put together called you dash prevent dot com. And there and they have really risk modeled and benefit modeled all of these new concepts so that you can put in all your patients characteristics and then you can put in the treatments and it will show you the number of years of life saves a number of events saved for each different tribute. Even have culture scene in there. Pcs key nine gazeta, meid resins statins etcetera. And it's very sobering because I'll go through there and I may put in what I think is the answer and it may come up and say very little risk reduction, very little benefit. So what I would recommend is that you go to this website and again, it really integrates risk and benefit in the most intelligent way that I've seen. So it's the way to way through the confusion. Okay great. Thank you very much. Uh Next another question. So we got a question here. Uh This is probably best for uh for Dr Gonzalez. Um There was a question about uh any role for cardiac stress testing and the asymptomatic patient with an elevated coronary calcium score. So I guess the question would be like, you know, you get a CAC on a patient scores around 500 but they're asymptomatic. Um You know or even you can say higher 790. Or whatever the number that is, would you is a role to get a stress test on that may be established a baseline, that kind of thing. Yeah. Most of uh I mean like the guidelines currently right now, they consider more than 400 severe uh if any patient is uh more than 400 on the calcium score. Uh it's uh it's an indication for a stress testing. Usually I tend to do non radiation, you know like stress testing, mostly treadmills or stress echoes um to get that functional testing. But anybody with about 400 I would I tend to have a lot of patients who have a lot of primaries or doctors who usually tend to order the ct afterwards. I my my my way around usually is the pain of how bad that calcium missed That Qasem is like 4000. I would definitely do not a city and I will be doing other types of investigations. Is just trying to find out the right testing. But yes and anybody about 400 and insurance and Medicare that is an indicator is approved. This indication for uh stress regardless of their uh symptomatic. Okay, all right, thank you. Doctor Gonzalez. Quick question. Uh productive cork. There was a question about how you actually start epidemic acid. Um you know, I think that's one of the newer agents and maybe there's some people that are not really sure how to kind of get that going. So any thoughts you have about starting actually starting that new therapy? Uh Yeah. Thanks. Great question. You know as we're getting more familiar with this agent, you know, I think everyone's got a building their familiarity in general. Um There's really no strict contra indications for Mehmedovic acid but there are some cautions we highlighted a little bit. These are things I think you got to keep in mind before initiating the medication. One is does the patient have a history of gout? Remember the uric acid level will increase? Um Second is is there a history of tendon apathy that that risk seems to be increased slightly with patients over 60 years old. Post patients on floor queen alone therapy patients already on concomitant steroid therapy. Be very careful if that history is there in prior tendon open. You may want to avoid this class. Um Really not advised in the lactation and pregnancy. Um And you know there's um be cautious of the drug drug interactions. Um nothing greater than simvastatin. 20 mg. Pravastatin greater than 40 mg. Also cyclosporin was one of those drug interactions um Really that was specifically in combination with the combination Mehmedovic acid, he said. Um I bob similarly um fiber therapy also contradiction in that combination. There are some so those are the main things I think I think about clinically um There are some copay cards that you know that we found to be helpful to get the patient initiated on on the medication with the use of prior authorizations just like these new drugs. Really getting a lot more patients on the medication. And have seen myself just seem nice, nice benefit. And a few very few complaints from the patients with regard to the tolerance the medication and as far as monitoring labs. Uh Do you get a uric acid level? Do you get a LFTs anything like that down the road? Yeah. Thank you. Yeah so that that those both are helpful. Um And particularly if you're on the combination with me um that lft periodically, it would be helpful. And then uric acid level has been recommended to be periodically check. You may want to check in every corner at least twice a year just to make sure that we do see elevation there. And so specifically patient had prior gout. Those patients have, they are specifically the patients who had a higher tendency to have recurrent gout on the medication. So you may need to help reduce the uric acid level with agents that help reduce it if you see it rising, particularly in high risk of the prior history of gout. So that's where you should be cautious. But exactly, I tend to order uric acid and LFTs. Okay, thank you very much. Unfortunately, we're We're out of time that we are speakers were a little more verbose today in the first session, so we don't have we need to take a 10 minute break and we're starting right at 1005 again, I want to thank our speakers for this morning was a really great start to our day. I'm really looking forward to the 1005 talk. Of course, that's my talk. So hopefully everybody will be there on time. Thank you very much. We'll take a break right now.
