SCOTTSDALE, Ariz., May 23 -- Sen. John McCain, the presumptive GOP presidential nominee, was among the multitude of Americans who stopped taking ezetimibe/simvastatin (Vytorin) after publication of the ENHANCE trial, which found the drug did not reduce plaque burden.
That was one of several medical facts revealed today during a teleconference with McCain's Mayo Clinic Arizona physicians -- an internist, a head-and-neck surgeon, and a dermatologist. The physicians called the 71-year-old McCain's health excellent and affirmed that he appeared sufficiently healthy to serve in the White House, despite his age and history of melanoma.
McCain's internist, John Eckstein, M.D., said he put McCain on the ezetimibe/simvastatin combo drug two years ago, but took him off the medication following the release of the ENHANCE data earlier this year (See ACC: ENHANCE Data on Ezetimibe/Simvastatin (Vytorin) Reveal Wavy Bottom Line).
According to Dr. Eckstein, McCain had only mild lipid elevations. But ezetimibe/simvastatin is not considered a first-line agent. Instead, it is an agent for refractory dyslipidemia or for patients who cannot tolerate high-dose statin therapy.
Dr. Eckstein said McCain "had an excellent response to Vytorin" but following release of the ENHANCE results, he took him off the drug and put him on simvastatin instead.
Questions during the teleconference focused primarily on the Arizona senator's history of melanoma. He has had four in the past 15 years, three in-situ and one invasive. The in-situ lesions were on his left shoulder, left arm, and left nasal sidewall, and were removed in 1993, 2000, and 2002, respectively.
The invasive melanoma, on his left lower temple, was removed in August 2000. All four lesions were primary melanomas.
Michael L. Hinni, M.D. a head-and-neck surgeon at the Mayo Clinic in Arizona, said the August 2000 lesion was 2.2 mm thick at its thickest part and was 2 cm in diameter.
"A 2-cm margin of normal skin was removed around the 2-cm melanoma, resulting in a 6-cm-by-6-cm roughly circular wound on the left side of the senator's face," Dr. Hinni said. "The underlying parotid salivary gland was also removed to assure a clear deep margin, to protect facial nerves from injury and to remove the sentinel and other lymph nodes that were inside the parotid gland."
Dr. Hinni said none of McCain's nodes showed any evidence of metastasis. He said McCain has been closely followed since 2000 and has remained melanoma-free since 2002.
McCain's dermatologist, Suzanne M. Connolly, M.D., said the senator regularly does skin self-examination and she said he has had a number of basal- and squamous-cell lesions removed over the years. The most recent was a non-invasive squamous cell carcinoma on the lower leg that was biopsied in February and excised earlier this month.
McCain has also had recurrent adenomatous polyps, Dr. Eckstein said.
"In the 1990 he had an adenomatous polyp removed and then he had two normal colonoscopies," Dr. Eckstein said. Then on April 1, McCain had six adenomatous polyps removed and he will be followed with yearly exams, Dr. Eckstein said.
McCain has had a history of kidney stones and gallstones. Dr. Eckstein said the senator was taking 12.5 mg of hydrochlorothiazide to reduce the risk of renal calculi, but he had just increased the dose to 25 mg.
The low-dose thiazide didn't have a big impact on McCain's blood pressure, which was 134/88 mm Hg.
His total cholesterol was 192, his LDL 123, and his HDL 42. His triglyceride value was not available.
His weight was 163 pounds and his height 5 feet 6 inches. Waist circumference was not available.
In addition to the simvastatin and hydrochlorothiazide, McCain takes a baby aspirin to prevent blood clots, cetirizine (Zyrtec) for nasal allergies, zolpidem (Ambien CR) as needed for sleep when traveling across time zones, and a multivitamin.
Although some reporters were allowed a brief period to view McCain's medical records and take notes, McCain did not allow copies of the records to be made for wide dissemination.