Dr. James A. Underberg, M.D.

Preventive Cardiovascular Medicine


HOMEFDA Statin Label Update CommentaryPRACTICE INFORMATIONPATIENT INFORMATIONWhat is a Lipidologist?Reasons to See a LipidologistOmega 3 Index TestingCOMMENTARYDownloadsFor Women over 50!Ladies Home Journal FeatureCLINICAL TRIALSBellevue Lipid ClinicHeart Run 2010 Please Donate

 Comments , Thoughts and New Information

Link to Dr. Underberg's Interview/Fox News/Dr Manny Familial Hypercholesterolemia

Listen to Doctor Radio Interview March 9th Dr. Fred Feit Show "Heart to Heart"

Listen to Health Interview on Heart Disease Signs & Symptoms 2/2010

Listen to Health Interview on Cardiovascular Disease Prevention 2/2010

Listen to Dr. Underberg's Recent Interview on Sirius Doctor Radio

Discussing Men's Health and Cardiovascular Disease Posted 2/12/1010

Click Here to Listen

View Good Moring American Interview of Dr. Underberg and Joe Theismann Discussing AAA!

Download Video File of Dr. Underberg discussing the importance of Blood Pressure Control with Tommy Lasorda

Click Here to Download File


Download file of Dr. Underberg discussing new diabetes drug

Click Here to Download File


Listen to Interview of Dr.Underberg on Public Radio Show "How To Save Your Life". Dr Underberg discusses Preventive Cardiovascular Medicine. (MP3 File May Be Downloaded)


Click Here To Download File


 Response to recent NY Times article about Crestor and statin use. (posted 3/31/10)

Recently the NY Times published an article entitled “ Risks Seen in Cholesterol Drug Use in Healthy People”   ( ) . The article raises questions about whether or not healthy patients with elevated high sensitivity C-reactive protein (hs-CRP)and other cardiovascular risk factors should be treated with statin medications even if their LDL cholesterol is normal. The article raises questions about whether or not statins are safe to be taken as preventive medicines.

The debate here should not be about whether or not statins work, nor on whether or not the drug has been proven to work on younger people. Statins do work, ask any young patient with familial hyperlipidemia, who would normally die by the age of 30. What this debate should center on is why; despite the introduction of statins is heart disease the number one cause of death in the US? It is because the cause of this disease, abnormal lipoproteins, the carriers of cholesterol are not measured by standard cholesterol tests. Most patients who have heart disease do not have elevated LDL (bad ) cholesterol. They do , however have elevated lipoproteins(specifically Apolipoprotein B(ApoB)).  Once Apo B lipoproteins start the process of atherosclerosis, inflammation begins, and tests like hs-CRP become elevated. Rather than wait for this to happen, simply indentify and treat the cause, the Apo B lipoproteins with statins  and other drugs along with lifestyle changes when appropriate. Many cholesterol disorders are genetic, and for these patients drugs offer the only option. For many obesity, diabetes, and poor dietary and exercise habits contribute to the abnormal Apo B lipoproteins. Simply  testing for elevated levels of Apo B  lipoproteins would identify many at risk long before hs-CRP was elevated.  Statins do increase risk of diabetes, and those patients with diabetes benefit the MOST from statins. The cause of this has not been determined.  Niacin increases diabetes risk, and again, those that benefits most on niacin are diabetics. Niacin is a natural b vitamin. The first statin came from the same yeast that produced penicillin. Treating with statins does more than simply preventing death from heart disease; it prevents strokes, especially in women. Preventing a nonfatal stroke is one of the best things one can ever do. There is much we still do not know, but there is much we do know, and have known for a very long time. For more that 50 years now it has been clear that Apo B lipoproteins cause atherosclerosis, yet many insurance companies still think testing for lipoproteins is "experimental". Medicare allows this test, and recognizes its value. Hs-CRP is variable and many patients who have elevated CRP , might not one month later. If it remains elevated over time it does signify cardiovascular risk. Just check the lipoproteins and for many they would never get to a point where hs-CRP  and statins are needed. If we found our younger patients at risk there would be more time to attempt correction of these abnormalities with lifestyle changes. The problem is not with the FDA, nor with pharma companies that manufacture statins. The problem is with our ever expanding waistline, and reversing this trend. With obesity comes increased Apo B lipoproteins, along with high blood pressure, diabetes. This drives the process of atherosclerosis. Statins are one small piece of the puzzle, but when used properly, in the right patients, those with elevated lipoproteins, can be helpful. You cannot prevent a problem if you do not know whether or not the cause is present. If more patients where checked for abnormal Apo B  lipoproteins then statins would be used more appropriately, and many would be identified and perhaps treated with lifestyle changes long before statins were required.

How do you check lipoprotein levels? Either my measuring Apo B levels in the blood. Apo B is a surrogate for LDL cholesterol particles. One can also measure LDL particle levels directly, and this method also includes traditional cholesterol values along with additional information about what the cause of the underlying cholesterol problem may be.

Simvastatin (generic Zocor) Highest Dose Linked to Muscle Problems (Posted 3/21/10)Recently the FDA released a drug safety communication about the increased risk of rhabdomyolysis and myositis (muscle breakdown and inflammation) at the highest dose of simvastatin(formerly Zocor) when taken at the highest dose of 80  mg when compared to the 20 mg dose. While those of us in the cholesterol community , lipidologists and  preventive cardiovascular cardiovascular specialists have suspected this to be the case for a while now, this confirms our concerns that the potential benefits of this high dose are significantly outweighed by the risk. Most of the clinical data supporting the benefits of simvastatin in lowering cholesterol in patients at risk for heart disease and reducing risk of cardiovascular events have been with doses of the drug between the 20-40 mg dose. When LDL cholesterol (bad cholesterol) is lowered more then about  30% these benefits are demonstrated. It takes somewhere between 20-40 mg of simvastatin to achieve this reduction, and this is the dose most patients use as prescribed by their physicians. When cholesterol targets have not been achieved often statin doses are increased. The  expected additional increase in cholesterol lowering when simvastatin dose is doubled from 40 to 80 mg (the highest dose) is only approximately 5-6 %. This minimal increase in cholesterol lowering is accompanied with an increased risk of muscle side effects. So why would one use the 80 mg dose of simvastatin? In most cases when 40 mg of simvastatin is not effective, doctors either add a second drug, or change the simvastatin to a more potent statin such as atorvastatin (Lipitor) or Rosuvastatin (Crestor).  Simvastatin however is generic and costs less , and many managed care organizations and prescription benefit companies require that patients  have been tried on the highest dose of zocor before they will approve use of a non-generic statin. We do not use the 80 mg dose of simvastatin because we do not feel the risk outweighs any potential benefit, and perhaps now, with this new information patients will not be unnecessarily treated with this dose prior to being switched to a drug that is more appropriate for them. If you are taking simvastatin 80 mg you  should discuss the use of this drug with your health care practitioner. Many patients do take this and tolerate it well. For some it is the only drug they can afford or can tolerate. Awareness of this data  , however  , is important for both patients and health care providers to consider when making treatment choices.

ACCORD Trial Update (posted 3/17/2010)

This week at the American College of Cardiology Meetings in Atlanta GA, the results of the ACCORD Trial were released. ACCORD stands for “The Action to Control Cardiovascular Risk In Diabetes”. This study had three parts, one investigating control of blood sugar, one investigating the control of blood pressure and the third investigating the control of lipids (cholesterol ,triglycerides etc) all in diabetic patients. The results of the diabetes study were reported last year showing no benefit in treating diabetic patients to very low blood sugars. The blood pressure was reported this past week, showing no benefit other than perhaps a reduction in stroke risk  when diabetics are treated to lower blood pressure targets. Finally on Sunday of this week the long anticipated results of the lipid study were released. These patients were diabetic and all were given a statin medication (Simvastatin) at a dose of between 20-40 mg. Half of the patients were given in addition to the simvastatin a second drug called fenofibrate. This drug lowers triglycerides, raises the good HDL cholesterol and in some patients lowers the bad LDL cholesterol. The thinking was that in diabetic patients there would be an additional benefit of treating cholesterol and triglycerides more aggressively.

The study results showed a trend towards benefit in the group that got the second drug, but this was NOT statistically significant, and hence the results were reported as neutral. There was also a trend towards worse outcomes in the women who got the fibrate, but again, this was NOT statistically significant. In looking at subgroups of patients, the one type that seemed to improve on the dual therapy was those patients with low HDL (good cholesterol) and elevated triglyceride levels.

What does this mean for patients? First, fibrates are safe drugs and can be used in combination with statin medication if needed. They are excellent drugs for lowering high triglycerides levels, and can be used in addition to statin medications to further lower LDL cholesterol and levels of lipoproteins (the carriers of cholesterol). Fibrates should probably be reserved for those patients with low HDL cholesterol and elevated trigyclerides (both components of something called metabolic syndrome) and often associated with obesity, high blood pressure and abnormal blood sugar, BUT in diabetic patients already on a statin if the HDL cholesterol and Triglycerides are normal, probably will not yield additional cardiovascular benefit.

If you are taking a fibrate (fenofibrate, tricor, gemfibrozil, trilipix, lipofen, etc) do not stop it on your own. Contact your physician and make an appointment to discuss the role of this drug in your lipid and cardiovascular prevention therapy .

Diabetes and Walnuts:potential cardiovascular benefits: posted 2/22/2010

This week at the American College of Preventive Medicine, where I chaired a symposium on "Cholesterol and Blood Pressure Guidelines" a very interesting research study was reported. The preventive medicine group at Yale University presented data showing that diabetic patients who supplemented their diets with walnuts had an improvement in the function of their arteries (called endothelial function). Often patients with heart disease or risk factors for heart disease (such as obesity, high blood pressure, abnormal cholesterol or erectile dysfunction) have abnormalities in endothelial function long before they exhibit signs of cardiovascular disease. The investigators also looked at changes in total and LDL (bad) cholesterol, showing a non-significant trend towards better cholesterol levels, but based on statistics reported the levels as the same in each group. There were no changes in sugar control blood pressure and most importantly weight. The patients were given 56 grams a day of walnuts. The fact that the patients did not gain weight suggests that health supplements such as walnuts may be filling and decrease additional food intake. While the results are encouraging, it is important to recognize that endothelial function is not a test that is done in most offices, and is used at this time almost exclusively for research purposes. In addition, measuring endothelial function has not been shown to improve cardiovascular outcomes. Since it does correlate with increased risk of cardiovascular events , improving it seems to be a good thing. Walnuts contain increased amounts of Omega 3 fatty acids, most often consumed from fish .  Other nuts, however , have also been shown to help diabetics such as almonds (which may improve blood sugar levels). Heathy snacks such as walnuts and almonds (non salted and non sugared) are reasonable for all patients, and may particularly benefit diabetics. For a complete review of this presentation see Nancy A. Melville's article on

Statins and Diabetes: Posted 2/18/2010

Yesterday a study was released in the British Journal LANCET. This study was a Meta-analysis (a study that reviews or combines many other studies into a larger group). The investigators reviewed 13 large studies done with drugs in the statin class used for lowering cholesterol. The studies needed to include more than 1000 patient and had to be longer than one year. Over all they looked at more than 90,000 patients.  When all the different types of statins were grouped together, those on statins had a 9% increased chance of developing diabetes as compared to those not taking statin medication. While the overall group met statistical significance, when the statins were stratified by specific drugs, the only medication that met statistical significance was Rosuvastatin (Crestor). This is in line with the results of the JUPITER Study, which demonstrated similar trends for this drug.

What is important to note about this study was that the beneficial impact of statins on reducing cardiovascular disease outcomes is not reduced, and in many sub-studies the groups of patients that benefit the MOST from statins are diabetic patients. Other drugs that lower cholesterol have also been shown to worsen blood sugar, most notably NIACIN. 

Should statins be avoided in diabetic patients? ABSOLOUTELY NOT. In fact, diabetic patients are one group that should be taking statins . What about a “pre-diabetic” patient? Should statins be avoided in this group? Again I would say no . If Cholesterol and Lipoprotein lowering is indicated, then statins should be used as per our current guidelines. If pre-diabetes exists, aggressive life-style modification is still the gold standard here, including weight loss , diet and exercise.

Diabetic and Pre-diabetic patients taking statins should NOT stop them, and if they have questions should discuss with their physician.

ARBITER 6 HALTS Study Update Zetia and Niaspan

Recently I attended the American Heart Association Meetings in Orlando Florida. Presented at the meeting were the results of the ARBITER 6 HALTS study. This was a study comparing two different drugs ADDED on to Statin therapy (such as Lipitor, Zocor etc). In patients with pre-existing heart disease with low -normal HDL (good cholesterol) levels. Both groups of patients started with VERY low LDL cholesterol levels (less than 100) and were given either Niacin (Vitamin B3) at very high doses (2000 mg a day) or Zetia . The study was a small study and was designed to look at thickness of the lining of the carotid arteries in the neck. The study was NOT designed to look at heart attack, stroke or other cardiovascular events. The study was stopped early (for no clear reason as safety was not and issue for either drug) . The results showed that the progression of plaque in the neck was delayed with both Zetia and Niacin (the drug was a long acting version of niacin called Niaspan), with Niaspan actually causing some regression of the plaque. Despite what the investigators speculated in the article ( and they were strongly chided by other specialists for these remarks) there were no “negative “ effects of Zetia.

It has been well know for a while now that Niaspan can cause regression of plaque in neck arteries as well as perhaps in the arteries around the heart, however no study has been able to show that regression of plaque is associated with a reduction in heart attack, stroke or death. The Niaspan was better at raising HDL cholesterol than the Zetia, and studies with zetia have already shown that is does not cause regression of plaque when added to a statin medication.

Statin medications have been well documented to reduce risk of heart attack and stroke, however several studies with statins have shown either no change in carotid plaque or only delayed progression , just like Zetia in this study.

So what does the study tell us? Not much that we already didn’t know before hand! Both Niaspan and Zetia are excellent drugs to add on to statins to further lower LDL cholesterol. In patients with pre-existing heart disease and low HDL cholesterol, Niaspan should probably be the next drug added to a statin . Niaspan is often difficult for some to tolerate, can cause flushing, can worsen peptic ulcer disease , can increase blood sugar and perhaps exacerbate gout. Neither Niaspan or Zetia should be used on their own unless Statins cannot be used first.

If you are taking Zetia DO NOT STOP IT. There is no reason to. If you have heart disease, low HDL cholesterol and are already on a statin, Niaspan MAY be indicated but not in everyone, as you may not need it or may not be able to take it.

If you need to discuss this further please schedule an appointment with me to discuss this further.

Dr Underberg

Cholesterol and Pregnancy Concerns for Mother AND Child

The story of cholesterol and pregnancy is a very interesting one. Cholesterol is an important building block for all cells in our body. We require cholesterol for cell membrane structure and function, and cholesterol serves as a precursor to many other substances such as hormones. It is important for brain development and required by the developing fetus for normal gestation. During gestation many changes take place that impact lipid and lipoprotein levels. There is a trend towards insulin resistance (pre-diabetes), accompanied by changes in proteins and enzymes that control triglyceride and VLDL (very low density lipoprotein) metabolism such as lipoprotein lipase, which causes an increase in triglyceride levels and VLDL particles.  There is an increase in the enzyme hormone sensitive lipase , which also contributes to some of these changes, and a reduction in hepatic lipase. This is induced by increasing estrogen levels, and along with increased production of a protein called apolipoprotein A1, leads to an increase in HDL (high density lipoprotein)  levels. Thus the typical trend during pregnancy is for an increase in LDL (low density) cholesterol, an increase in triglycerides, and an increase in HDL cholesterol.

These changes in many women are physiologic and minimal. For a woman with gestational diabetes they can lead to severe elevations in triglycerides in the third trimester, which in some cases may necessitate hospitalization. The increase in cholesterol and VLDL particles, until recently has been thought to be of no long term danger to the mother. As most cholesterol lowering medications are either pregnancy category D or X (Dangerous), and should not be used during pregnancy, treating cholesterol disorders or women with very high cholesterol during pregnancy has been thought to be more dangerous than the consequences.

A recent article published in Current Opinion in Lipidology in 2009, reviews the data regarding women with very high cholesterol levels from genetic causes (Familial Hyperlipidemia) (otherwise known as FH). Women with FH have very high cholesterol levels from birth, along with a family history of early or “premature heart disease”. In the most severe form, these patients often die in the second or third decades of life from cardiovascular causes. In a less severe form (heterozygous FH or HetFH) the heart disease becomes symptomatic in the 4th or 5th decade of life.  While a 9 month hiatus from treatment for these women may not significantly affect long term heart disease risk, the potential long term effects on the fetus, being exposed to very high cholesterol levels that actually worse during the pregnancy is only now beginning to be understood.

Studies done from autopsy studies in young children who die from other causes, combined from accumulating evidence from animal studies suggest that this in-utero exposure to elevated cholesterol levels increases the likelihood that early markers of atherosclerosis will be present in the offspring of mothers with FH. Therefore maternal cholesterol levels even for the 9 months of pregnancy may impact future cardiovascular risk status of the child.

What does this mean for treatment? Currently there is only once class of lipid lowering medications that can be used safely during pregnancy, bile acid sequestrants. They are pregnancy category B. This class of drug is not ideal, however, as it can raise triglycerides. As this is a concern as pregnancy progresses, I does not represent a reasonable option for most throughout the full term of gestation. We must, therefore, aggressively promote the importance of diet and lifestyle in non-pregnant female as not only important for maternal well being but also for the offspring as well. During pregnancy, women are often told not to worry as much about diet. This may need to change, and especially in those women with FH, or other cholesterol disorders, perhaps seeing a lipiodolgist (cholesterol specialist) along with a nutrition specialist with expertise in both lipids and pregnancy would be reasonable. Finally, there is always the possibility of new pharmacologic interventions being developed, however, clinical trials testing safety in pregnancy would be very difficult to conduct.

References1.Pregnancy in women suffering from familial hypercholesterolemia: a harmful period for both mother and newborn? Current Opinion in Lipidology  2009, 20:484–490 
2. Lipoprotein metabolism and vascular complications in pregnancy.  Clin. Lipidol. 4(1), 91–102 (2009)
3.  Influence or maternal nutrition on the metabolic syndrome and cardiovascular risk in the offspring  . Clinical Lipidology (2009) 4(2). 145-158

What does the new Crestor indication mean?

Today the FDA approved a new indication for the Statin Crestor (Rosuvastatin). In addition to its prior indications to lower cholesterol, triglycerides and to delay the progression of atherosclerosis, it is now approved for primary prevention (patients with NO history of heart disease or stroke) with normal LDL cholesterol and elevated high sensitivity C-Reactive Protein (hs-CRP) (>2 mg/dl)  in men >50 years of age and women >60 years of age WITH  additional risk factors for heart disease (low HDL cholesterol, hypertension, family history of premature heart disease or smokers). The recommendations were based on the results of the JUPITER Trial (Justification for the Use of statins in Prevention: an Intervention Trial Evaluation Rosuvastatin).

It is important to remember that this study looked at a large number of patients over several years. Over 90,000 patients were screened so as to obtain the necessary number of patients who qualified with normal LDL cholesterol levels and elevated hs-CRP levels. More than half of the patients enrolled in this study had hypertension, and were overweight. The entry level blood sugars were in the upper range of normal. In addition, many of these patients had elevated levels of apolipoprotein B, a marker of increased cardiovascular risk.

Hs-CRP levels are elevated in patients with inflammation related to atherosclerosis, but are also elevated for many other conditions that cause inflammation. A simple cold, ankle sprain or dental infection can all cause an increased hs-CRP level. When evaluating 18000 patients over several years (as was done in the JUPITER study), the individual variations in hs-CRP testing are less significant. There is no doubt that it is a good predictor of cardiovascular risk for populations of patients. The concern, however is its usefulness for an individual patient. The FDA panel today made it clear that there is no data showing treating to lower hs-CRP levels is beneficial for patients, and it “did not allow for comparison between individuals with an hsCRP < 2 mg/L to those with an hsCRP > 2 mg/L”.

Crestor is an excellent Statin medication for lowering LDL cholesterol, Triglycerides, along with Non-HDL cholesterol and Apolipoprotein B levels. Its benefit in primary prevention, for BOTH men and women was well documented in the JUPITER trial. While hs-CRP levels, if elevated over time may truly represent a patient at risk for cardiovascular disease, the patient and practitioner should make sure to evaluate the complete picture. Smoking, Hypertension, Family History, Low HDL cholesterol and most importantly, elevated APO-B containing lipoproteins, as measured by Non-HDL cholesterol, Apolipoprotein B levels, or LDL particle levels.


1.       Questions and Answers for Healthcare Professionals: CRESTOR and the JUPITER Trial


2.       JUPITER Trial: Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein N Engl J Med 2008 359: 2195-2207

3.       ApoB versus non-HDL-C: What to do when they disagree  Current Atherosclerosis Reports 2009, 11:358363

Dr. Underberg and Joe Theismann Discussing Aortic Aneurysm Screening

Tackling AAA
A bone-crunching tackle prematurely ended the football career of former Washington Redskins quarterback Joe Theismann in November of 1985 in a memorable game with the New York Giants. Voted the most shocking moment in NFL history, it was one that he, and many sports fans, will never forget. But although he moved on to become a successful sports commentator and recently made a cameo appearance in the new sports blockbuster movie, The Blind Side, Joe recalls another moment in his life that was just as shocking. 
It was five years ago when his 89-year-old father, Joseph John Theismann, told him he’d been diagnosed with an aneurysm, a bubble that forms in the artery that carries blood to and from the heart. “My dad told me he was ‘fine,’ not to worry,” Joe, a native of South River, N.J., recalls, “so I went along with it. I should’ve known better.” 
Twenty-seven years before the aneurysm was diagnosed, Joe’s dad also had open-heart surgery. And since then he’s had multiple stents implanted to open clogged arteries caused by atherosclerosis. “He was fine then, too,” says Joe. “My father is that breed of human that says he’s fine no matter what’s going on.”
An eye-opening coincidence
At that time, the high-profile sports commentator and analyst also got a call from a group looking for a spokesperson to help get the word out about a little-known condition—abdominal aortic aneurysm  (AAA). The group, Find the AAAnswers (, wondered whether Joe knew anyone with the condition. 
“I told them my dad had just been diagnosed with an aneurysm, but I didn’t know if it was triple A,” he says. So he asked his father for the specific diagnosis—it was AAA. Joe began learning about AAA, and realized how lucky his dad was to be alive. He became the group’s spokesperson, and began urgently educating others about the condition through speeches, radio and television interviews, and other media appearances.  
Why the urgency? According to Find the AAAnswers, about a million people in the U.S. are walking around with the condition right now—and don’t know it. “My dad was one of those people,” Joe states. People with AAA often don’t experience any noticeable symptoms, making the condition a silent killer and the third-largest cause of death in men over 60 years of age. “If an aneurysm goes undetected, it can burst,” Joe explains, “and you’ve got only a 10% chance of surviving.”
Orange alert
To make people more aware of AAA, Joe often wears orange suspenders at TV and public appearances. “They’re a visual aid—they cover the areas of the abdomen where these aneurysms occur,” he explains. Raising awareness is key to preventing sudden deaths caused by ruptures. If AAA is detected early, doctors can prevent the bubble from bursting, typically by implanting stents that not only unclog arteries, but also provide extra strength to weakened artery walls. 
Detection is accomplished through an ultrasound, a painless procedure that takes about 10 minutes and lets the doctor see what is going on in blood vessels. It can be done during a physical and men over the age of 60 should have it done annually. 
Most men are happy to find out that the ultrasound doesn’t require special scheduling or preparation. “After all, at one time, if I had a choice between going to a doctor’s appointment and playing a round of golf in the rain,” Joe jokes, “I’d buy a wetsuit.”
Now, however, he makes it a point to get an ultrasound at annual checkups. The fit 62-year-old’s family history of heart disease puts him at higher risk for AAA. Both his father and mother have atherosclerosis. And heart disease of any kind is a major risk factor.
But risky behaviors, like smoking, can also cause AAA (see “What Puts Me at Risk for AAA?”). “Smoking,” Joe stresses, “is a big risk factor. My dad quit smoking almost 40 years ago, but it likely contributed to his condition.” 
Living in Virginia with his third wife, Robin, Joe says he feels blessed. “My dad and mom are still with me in this world,” he says. “That makes me a very lucky man.” 
When it comes to AAA, though, luck doesn’t apply. “You have to take responsibility and make sure you get tested,” Joe concludes. “If you don’t, you won’t really know if you have triple A.” And early detection ups your odds of survival to 95%, Joe notes. “Those are really good odds.”  
How Is AAA Treated?
The sooner AAA is detected, the better. Early detection determines your best course of treatment, according to James A. Underberg, MD, clinical assistant professor of medicine in the division of general internal medicine at New York University Medical School. Dr. Underberg specializes in preventive cardiovascular medicine. 
“Treatment for AAA depends on the size of the aneurysm [a bubble in the aortic artery]. If it’s small—between one to two inches—doctors watch it closely,” explains Dr. Underberg. “We also recommend quitting smoking immediately, keeping blood pressure under control, lowering cholesterol if it’s too high, and losing weight if you’re too heavy.” All of this helps to slow aneurysm growth. In some cases, doctors also prescribe medication to reduce the blood pressure on the aneurysm.
When an aneurysm is larger than two inches, surgery is needed to remove it. Often, surgeons perform endoscopic vascular repair, which does not require a large abdominal incision. Instead, a stent (a tube made of metal mesh) is inserted via catheters through the groin and into the artery. The stent is secured in the abdominal aorta to support the weakened area of the artery. 
A second option is open surgical repair. Surgeons create an incision and replace a section of the aorta with a tube. Recovery from both procedures is fairly rapid, according to Dr. Underberg, and the likelihood of AAA recurrence is extremely low. 
—Kathy Gilligan
Heart Care Health Monitor
Winter 2010