Hi XXXX,
Thanks for writing in to us.

I have gone through your query and attached report in detail.

The interpretations I would like to make are
1. Serum lipids: are VERY high

Cholesterol 649
Triglycerides 980
Cholesterol/ HDL ratio 15.45

2. Blood urea nitrogen 34 (marginally high)

3. Serum creatinine 1.69 (marginally high)

4. GFR (Glomerular filtration rate) 32 Low

5. Urine Total protein/ creatinine ratio 1498 (very high)

Discussing about familial hypercholesterolemia (FH):
The goal of FH treatment is to reduce the risk of Coronary Heart Disease (CHD) or risk of a CHD-equivalent condition (eg, diabetes, peripheral arterial disease).

In the absence of symptoms or signs suggestive of a particular disorder, a limited workup should be performed to rule out secondary hypercholesterolemia.
Basic tests to rule out diabetes, hypothyroidism, hepatic disease, and renal disease are usually sufficient. Please discuss your kidney condition and the possibility of statins having an adverse effect on your kidneys with your cardiologist.

It is important you get treated for your condition and consult a cardiologist nearby.

As per your request, I would like to make a suggestion regarding your desired information on a Cardiologist at Oahu, Hawaii.

1. Dr. Gregg M. Yamada, MD and Dr. XXXXXXX Y. Wong, MD
Cardiologists
Pacific Cardiology
550 S Beretania St Suite 601
Honolulu, HI 0000

2. Dr. XXXXXXX M. Dang Jr, MD and Dr. Atsushi J. Terakubo, MD
Cardiologists
Cardiology Associates Inc
550 S Beretania St Suite 601
Honolulu, HI 0000

The above information was found by conducting online search.

It is requested that you may please verify credentials and details regarding treatment that should be acceptable to your insurance provider and you.

WWW.WWWW.WW and myself are in no way associated with the suggested doctor or any other third party for any research or commercial benefits associated in providing you with necessary information.

Hope your query is answered.

Dr A Rao Kavoor

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Hi XXXX,
Thanks for writing back.

Let me explain your medications in detail

1.     Atacand (candesartan cilexetil), a prescription medication for the treatment of heart failure and hypertension. It should be used with caution in patients with severe renal impairment. In heart failure patients receiving Atacand, hypotension, increases in serum creatinine, and hyperkalemia have occurred. Caution should be observed when initiating therapy. Evaluation of patients with heart failure should always include assessment of renal function and volume status. Monitoring of blood pressure, serum creatinine, and serum potassium is recommended during drug dose escalation and periodically thereafter.

2.     diet, has been approved for the treatment of high cholesterol. Increased eGFR was noted after weeks of treatment with pitavastatin, which suggests a possible effect of the statin on CKD. Effects of pitavastatin (Livalo tablet) on the estimated glomerular filtration rate (eGFR) in hypercholesterolemic patients with chronic kidney disease.

3.     Fenofibric acid
Impaired Renal Function
In patients with mild-to-moderate renal impairment, treatment with Fenofibric Acid tablets should be initiated at a dose of 35 mg once daily, and increased only after evaluation of the effects on renal function and lipid levels at this dose. The use of Fenofibric Acid tablets should be avoided in patients with severe renal impairment.

4.     Welchol (colesevelam hydrochloride) is a non-absorbed, polymeric, lipid-lowering and glucose-lowering agent intended for oral administration. Colesevelam hydrochloride is a high-capacity bile acid-binding molecule.
Renal Function.
No differences in safety and efficacy between patients with CrCl less than 50 mL/min and those with CrCl of 50 mL/min or more.

5.     Vesapa could not be found. Please send in drug details by chemical name.

Considering the ones explained above, Livalo and Welchol are safe. Atacand and Fenofibric acid should be given after renal assessment. I hope your doctor has seen benefits in your case. As you are on a set of drugs already, it would not be wise to recommend any other drugs for the reason that the ones you are taking are among the latest and relatively best for your condition. Your muscle pain might need consideration. You could use pain reliever ointments as such but must consult doctor before taking non steroidal anti inflammatory drugs (NSAIDs) in tablet. Atacand while taken along with NSAIDs need to be regularly monitored by doing renal function tests and serum potassium levels.

Hope your query is answered.

Dr A Rao Kavoor

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