Dr. Pam R. Taub talks with Diabetes in Control Publisher Steve Freed at the 2016 AACE Meeting. In part 5 of this Exclusive Interview, Dr. Taub explains her effective methods of treating the patient that may benefit other medical professionals.
Dr. Pam R. Taub, MD, FACC is a board-certified cardiologist who focuses on general and preventive cardiology. As a general cardiologist, she works with patients to diagnose and prevent heart disease, as well as manage conditions such as hypertension (high blood pressure), diabetes, coronary artery disease, or heart failure. Her own research—focused on how epicatechin (a compound found in dark chocolate) can improve mitochondrial structure and exercise capacity in patients with heart failure and diabetes—has received funding from the National Institutes of Health and the American College of Cardiology, and has resulted in multiple publications in top journals. She is also developing and testing new biomarkers (blood tests) to predict cardiovascular risk, as well as studying the mechanisms of statin-related muscle complaints and decreases in exercise capacity and using epicatechin to treat them.
Transcript of this video segment:
Steve: You’ve had successes with your patients, so what kind of things that you do that you found to benefit your patients that other medical professionals could do?
Dr. Taub: That’s a very good question. There’s a lot of things that I do that I think have been very important to my patients not having heart attacks and strokes and the preventative cardiologist. I focus very much on prevention and one of the ways I do that is by really looking at biomarkers. Those are blood tests that can give us a lot of insights into what’s going on. I have a standard set of blood tests that I check that’s a little bit different from what most people, a primary care physician, would do. I usually will do a panel called NMR Lipo-profile which has LDL particle number, which is particularly important in diabetics, because LDL levels can be normal or low, but the LDL particle number will come back high. It will push me to be much more aggressive with treatment. I also check for something called Lipoprotein(a) or LP(a), which is also an important biomarker to predict cardiovascular risk. I also check high sensitivity CRP. I’ll put all this together in determining how aggressive I need to be. I also believe in testing things like vitamin D that are very evidenced based because low vitamin D levels are associated with a lot of different metabolic derangements. The other thing that I also believe in is many of my patients have arrhythmias or palpitations, so I check a blood test called RBC magnesium. I don’t check blood tests frequently but the first time the patients see me, I’ll get some good standard set of labs to really risk stratify the patient. Is this somebody that needs to see me more often? Is this somebody that I need to be more aggressive with? Those blood tests help me with that. The other thing that I think I do a little bit differently is I do believe in dietary changes and lifestyle changes. I’m not a person to push the statin on immediately, I do go through a lot of other things. Many times those lifestyle changes are successful before instituting the medications. When I do start a medication, I always believe in doing the lowest possible dose and titrating it. A lot of times patients get put on a statin and they’re just basically kept on it for the rest of their life. If I see patients making good changes, I like to reduce medications. If patients are exercising more and their blood pressures are getting better, I will take the doses of blood pressure medications down by half. Those are all things that I like to do. I also screen very extensively for sleep apnea, because sleep apnea is associated with high blood pressure and a lot of patients with diabetes also have sleep apnea. Treating sleep apnea often allows you to reduce medications. That’s another important thing that I screen for. I think in terms of unique aspects of my practice, it’s really listening to the patient and understanding what their life is, what they want to get out of their life, and helping them get there through, whether it’s medications or through lifestyle modification.
To view other segments in this video series:
Part 1: A Cardiologist’s Perspective on Diabetes
Part 2: New Cholesterol Drugs PCSK9 Inhibitors
Part 3: PCSK9 Side Effects
Part 4: Working with Diabetes Patients
Part 5: Advice on Treatment Methods
Part 6: Starting on PCSK9s
Part 7: Recommending New Drugs
Part 8: Results of Using New Drugs