Lipidologist Dharmesh S. Patel, MD, has national impact on prevention 

By BECKY GILLETTE

Cholesterol levels are one of the strongest predictors of an adverse cardiovascular event, especially if a patient has already experienced a heart attack or stroke. Research has clearly shown that people with optimal levels of LDL and HDL cholesterol had the best survival rates. Unfortunately, only about three out of ten patients get cholesterol levels into the recommended range of LDL less than 55 mg/dL with established ASCVD (atherosclerotic cardiovascular disease) as per 2022 cholesterol guidelines (ECDP 2022).

Dharmesh S. Patel, MD, FACC, a lipidologist with Stern Cardiovascular, opened lipid clinics at Stern’s Walnut Grove and Southaven campuses in mid-2024 because of his laser focus on preventing cardiac events with better management of lipids.

Statins are an important medication for cholesterol management that have proven to be very safe. But some patients either just don’t want to take statins or cannot tolerate them.

“Some patients have high bad cholesterol, some have high triglycerides and some have low good cholesterol,” Patel said. “There are people who might be opposed to statin medications because of misinformation on social media. The information is highly inaccurate, but it changes perceptions. A lot of patients refuse to take statins even though they are well researched and proven over the past 30 years. Reducing cholesterol is very important.”

Patel said there are now innovations to address patients who can’t or won’t take statins. Injection therapy to lower LDL can be given biweekly or once every six months. There are new non-statin medications to reduce LDL. A therapy is coming out soon to reduce lipoprotein(a)—Lp(a)—a genetic cholesterol more likely to stick to arteries and lead to dangerous cardiovascular events.

Patel said one of the most important cardiovascular tests often overlooked is a coronary calcium scan which measures calcified deposits in the heart vessels.

“Calcium deposits have been shown to be the strongest predictors of cardiovascular events, even more so than blood pressure, cholesterol, blood sugar and diabetes,” Patel said. “The $99 test that takes ten seconds generally should be done in patients over the age of 40 and repeated every five years. Once abnormal, generally it should not be repeated. It is useful for patients who do not have known ASCVD, i.e, heart attack, stroke, etc. The calcium score test is a cost effective, simple test. I save several people a week by detecting their high calcium scores. That is why you never judge a book by its cover.”

If your calcium score is not zero, depending on how high the calcium score is and factoring in your age and other cardiac risk factors, Patel recommends consulting a healthcare professional for possible medication management and more importantly, lifestyle improvements.

“The ‘power of zero’ means you have less than a one percent risk for the next 10 years for a cardiovascular event,” he said. “Generally speaking, a calcium score less than 100 is considered low risk, 101-399 is moderate risk and more than 400 is high risk. However, age also factors into it. A calcium score of 99 is high for a 42-year-old.”

Patel is particularly interested in helping with complex lipid cases including patients who are having recurrent events.

Patel has national stature in lipidology serving on the National Board for the American Society of Preventive Cardiology Board of Directors and on the National Southeast Board for the National Lipid Association. He is president of the Partnership for Advanced Cardiovascular Health (PACH), which highlights healthcare advocacy including by identifying and working to resolve barriers to treatment access.

“Everyone knows about patients having to go through prior authorization, and all the tactics used by insurance companies to reduce costs without taking into account the clinical experience of healthcare professionals,” Patel said. “Another barrier is from pharmacy benefit managers who act as middlemen between insurance companies and pharmacies who essentially profit from the whole situation.

“Two of the top 6 six Fortune 500 companies in the USA are U.S. healthcare businesses. The only companies larger than health insurance companies are Google, Walmart, Amazon and Apple. That tells you how much money the healthcare insurance companies are making (United Healthcare, CVS Health). It is a vertical silo monopoly. Insurance companies will make it more difficult for healthcare providers to provide therapy. Some insurance companies deny FDA-approved therapy for no reason whatsoever.”

A recent report in the Wall Street Journal stated that insurance companies deny 850 million claims per year. The WSJ article highlights how difficult it is for patients to get the therapies that doctors have prescribed, and the amount of red tape and hoops doctors have to jump through.

Patel sees the insurance companies’ frequent denials as counterproductive as it has been shown that, generally speaking, every dollar spent on prevention reduces future healthcare costs by $3. An example is that by reducing LDL by 40 points, cardiovascular events are decreased approximately 20 percent.

As president of PACH, Patel’s patient advocacy includes lobbying on Capitol Hill.

“A lot of our patients are voiceless, so we try to be their voice in Congress,” Patel said. Patel also serves as the ACC Governor for Mississippi. “Some of the states with the highest rates of illness like Mississippi have some of the strictest restrictions on therapies in the U.S. People are not getting the therapy they need. It is something like malpractice, to be honest. Insurance companies, instead of doctors, dictate therapy for a patient’s disease. We are treating patients depending on their insurance, not the disease that they actually have. There are three people in the exam room – the patient, healthcare professional and the insurance company.

Patel anticipates positive developments coming out soon including the results of research trials on increasing HDL and possibly a vaccine for high cholesterol.

Another area of progress is trials with weight-loss drugs such as semiglutide (Brand name Ozempic) that have been shown to reduce cardiovascular events for people who are obese and have cardiovascular artery disease. Patel said obesity is a growing epidemic in the U.S. and important because obesity impacts about 70 other medical conditions, in addition to cardiovascular disease.

He also sees that artificial intelligence has great promise for being pivotal as cardiovascular science progresses. “I think there has been an amazing amount of progress in AI in a short few years,” he said.

Patel has great hopes for the future of CVD as he strongly believes cardiovascular disease is predominantly a preventable condition.