Statin - No Longer an Island

[Phyllis]

P.J. I take 10mg Zetia and was also taking 20mg. Pravachol until I took myself off it this week. The Pravachol on its own ( a relatively low dose) did not bring the numbers down so last year the doctor added the Zetia and they came right down to normal or a little under. That's why I'm interested to see if the Zetia alone will do the trick, but not even sure if low numbers have anything to do with blocked or clean arteries. Dick's arteries were also clean at the time of his avr and his doctor put him on Zocar this fall because his CHL was slightly elevated. He has cut back on that and is going to talk to his doctor about it as well when we get home in the spring. I buy mine through drugstore.com at the prices quoted by Jeff. Target and Walmart now offer the generics of the statins for much less, (I believe $7 or $10) but there is no generic yet for Zetia.

 

[hensylee]

P.J. I took Lipitor for years. It crippled me so I quit for about a yr when my cholesterol went back up and my dr persuaded me to start up again. I did for awhile and finally decided I would not be able to walk at all if I continued it so I told my dr & my cardio that I refused to take it. Cardio rxed Zetia (10 mg) - once per day. It certainly stopped the progression of the worsening of the walking, but I am left with the inability to walk like regular folks. I was recently persuaded a few months to take another type of med w/statin. I gave it up after 3 days because just that quick my muscles were again very weak. I have not told my dr. He wanted me to get my triglycerides down. If I am in pain and unable to get about, and have to give up a med to let me maneuver, then give it up I will - and did. Some of us just cannot take statins - my cardio told me that.

 

[PJmomrunner]

JeffP - Thanks for the info. I found on Drugstore.com--Dad's preferred supplier-- that only a 10mg pill was listed which, more or less, prompted my question. It looks like a lesser dose of Lipitor combined with Zetia would be comparable in price. I'd love to see his side effect symptoms disappear; it seems like it's worth a try.

Phylliss - Your experience with Pravachol and then Pravachol plus Zetia is encouraging. I will be very interested to hear how your numbers are affected. Thanks for sharing your dosing.

 

[PJmomrunner]

Ann - It's really a crying shame when a drug that can do so much good does so much harm. I do believe drug companies are in the business of making and selling drugs to improve people's quality of life and longevity, but it really does seem criminal to give a woman a drug that has never been shown to help women. Why is that okay???

 

[Susan BAV]

Ann - It's really a crying shame when a drug that can do so much good does so much harm. I do believe drug companies are in the business of making and selling drugs to improve people's quality of life and longevity, but it really does seem criminal to give a woman a drug that has never been shown to help women. Why is that okay???

I've become a cynic I guess. I wonder if they're in the business to get/keep everyone on meds. In theory, the idea should be to cure people, not addict them. But to cure would be to kill the goose that lays the golden eggs for all of the investors.

 

[Nan]

I wonder when the studies say that the statins don't help women period, if that means that reducing cholesterol (at least for a woman) does absolutely no good in terms of prevention. Sooo the idea that cholesterol causes plaque and clogs the arteries.....not correct?

With someone like me with genetic high cholesterol when diet and exercise don't impact on levels one wonders what can be done.

I guess at this point I am just rambling as it is a bit confusing (to me)....

But one thing is clear, these medications are terribly overprescribed.....Both Dennis' story and Shezagirly's mother's situation are illustrative of that problem.

 

[tobagotwo]

Susan BAV: where did you find that quote about anesthesia and beta blockers? That is quite a find. Please let me know if you remember.

Also, as far as drug side effects: that's not entirely the drug companies' fault. The fact is that it is incumbent upon physicians and patients to report adverse reactions to drugs. Your doctor likely doesn't have time. Very few actually report adverse effects. They just switch the patient to a different drug and let the market speak for the result.

How many of us patients have reported adverse reactions? We somehow think "someone" should automatically "know" about the problem we had. Plainly, that doesn't happen. No clairvoyants at the FDA. No feedback to the FDA, no new warnings on drugs. It's everyone's fault. Manufacturers can point accurately and honestly to having few side effects on drugs simply because very few people report them. Even with the money involved, most drug manufacturers would rather know before people start having tragic reactions, and find ways to restrict their products to those they will help. Not 100% good guys, but nothing like the devils they're painted to be.

Nan: There are distinct differences in the way that men and women tend to develop coronary artery disease. Men seem to develop blockages in the main coronary arteries. Women seem to develop blockages in the many small arteries instead. That may explain part of the reason that statins may have less effect on women's blockages than men's. Of course, there isn't nearly as much research into women's heart problems as men's (apart from birth control - which in many ways is largely about men, anyway - is there enough research on women for anything medical?).

Best wishes,

 

[Susan BAV]

Susan BAV: where did you find that quote about anesthesia and beta blockers? That is quite a find. Please let me know if you remember.

Also, as far as drug side effects: that's not entirely the drug companies' fault. The fact is that it is incumbent upon physicians and patients to report adverse reactions to drugs. Your doctor likely doesn't have time. Very few actually report adverse effects. They just switch the patient to a different drug and let the market speak for the result.

How many of us patients have reported adverse reactions? We somehow think "someone" should automatically "know" about the problem we had. Plainly, that doesn't happen. No clairvoyants at the FDA. No feedback to the FDA, no new warnings on drugs. It's everyone's fault. Manufacturers can point accurately and honestly to having few side effects on drugs simply because very few people report them. Even with the money involved, most drug manufacturers would rather know before people start having tragic reactions, and find ways to restrict their products to those they will help. Not 100% good guys, but nothing like the devils they're painted to be....

Reporting adverse reactions: we can report our suspicions of such but how many reports get dismissed, ignored, pooh-poohed, etc. (as did many of our serious valve-failing symptoms)? I think too that most of us don't want to deal with the hassle of another doctor appointment and/or the resulting experience of having the (usually) well-intentioned doc express his disappointment/frustration with us for not continuing with his recommended course. It's much easier to toss the remainder of the meds and hunker down until whatever issue and/or symptom passes.

And I believe this is also a common experience: I've had maybe a half a dozen or more doctors intensely try to put me on cholesterol lowering medications over the past decade but my instincts (right or wrong) screamed, "No!" [I'm thinking, "...good cholesterol is very high so why fiddle with something that may or may not be alright already and put more chemicals in my system that may or may not work in who knows what manner..."] It was a real struggle of wills for me to avoid taking that stuff. Doctors do not like it when you don't take their advice.

I'll look for that page where I found that fascinating anesthesia/beta blocker paragraph, Bob.

 

[Susan BAV]

Susan BAV: where did you find that quote about anesthesia and beta blockers? That is quite a find. Please let me know if you remember....

Found it: http://www.rxlist.com/cgi/generic/betapaceaf_wcp.htm

Look halfway down the page.

 

[Susan BAV]

...Sooo the idea that cholesterol causes plaque and clogs the arteries.....not correct?

With someone like me with genetic high cholesterol when diet and exercise don't impact on levels one wonders what can be done.

I guess at this point I am just rambling as it is a bit confusing (to me)....

But one thing is clear, these medications are terribly overprescribed.....Both Dennis' story and Shezagirly's mother's situation are illustrative of that problem.

I do recall, Nan, hearing a few years ago that cholesterol levels were not the complete cornerstone markers of heart disease indicators as once believed. When [that report] was released, it did offer another opinion as to a better marker but I'm not remembering exactly what it was -- maybe a blood protein or something.

Anybody remember that info?

 

[Adrienne]

I think the protein you are referring to, Susan BAV, is C-reactive protein.

 

[Nan]

Thanks Bob, Susan and Adrienne for trying to clarify the situation with women and cholesterol. Here's hoping that the medical researchers are doing ,or will do, some studies on women! Hey, we deserve it!

 

[tobagotwo]

I dredged this out of one of my posts in another thread:

If you have a bad reaction to a drug, even if it's one listed on the bottle or the web, you should report it. Don't count on your doctor to do it, as many of them won't. Your report helps get bad drugs off the market, or can help determine the best ways and times to use good drugs. Here's a place in the US to report these ill effects from drugs that you are taking (they are termed "adverse reactions"): http://www.fda.gov/medwatch/index.html Your report may save a life, or keep someone from suffering poor quality of life for no good reason.

Reactions are gathered without judgement. They don't grade the likelihood of your claim. As such, they are all counted. If enough people say the same thing, they tend to believe there must be some truth in it, even if it doesn't make sense onthe face of it. It's actually not a bad system, except that too few people use it.

Best wishes,

 

[Susan BAV]

Adrienne -

From Medline Plus regarding the C-reative protein and abbreviated as CRP:

Recently, new studies have suggested that CRP may also be elevated in heart attacks. The role of CRP in coronary artery disease remains unclear. It is not known whether it is merely a marker of disease or whether it actually plays a role in causing atherosclerotic disease. Many consider elevated CRP to be a positive risk factor for coronary artery disease.

That must be the thing I had read about.

 

[Susan BAV]

I dredged this out of one of my posts in another thread:

If you have a bad reaction to a drug, even if it's one listed on the bottle or the web, you should report it. Don't count on your doctor to do it, as many of them won't. Your report helps get bad drugs off the market, or can help determine the best ways and times to use good drugs. Here's a place in the US to report these ill effects from drugs that you are taking (they are termed "adverse reactions"): http://www.fda.gov/medwatch/index.html Your report may save a life, or keep someone from suffering poor quality of life for no good reason.

A few or several times on this site have been threads discussing a strange double vision episode a lot of us valvers have experienced. The first time that I experienced it, maybe in the early 90's, I went to my doctor and he reported it to a pharmaceutical company whose medication I was taking. They briefly hounded me, by mail and by phone, wanting access to all of my medical records to investigate the thing. I found it a big invasive hassle.

I think they already know what their product does and/or can do, whether it be good or whether it be bad. Reminds me of that Tommy Lee Jones/Harrison Ford movie, "US Marshals," I think. Maybe I'm not cynical; maybe I've seen too many conspiracy movies!

 

[tobagotwo]

At best, cholesterol is a risk factor, or it may turn out to be more of a risk marker. And perhaps not a reliable one at all in women. That doesn't mean men below 65 (or above 65 with heart disease) shouldn't try to lower their risk factors, cholesterol included. Just try to find perspective, balance any side effects against gain.

But in the doctor's office, it's all about risk: Fear, Uncertainty, Doubt (FUD). It's a reasoned argument. Why would you not avail yourself of something that could lower your risk of heart attack by [insert percentage here]? Note: Turn and appeal to patient's loved one, to enlist their help to make this person "do the sensible thing for his/her own good." In fact, any percentage mentioned would be questionable: most statins carry disclaimers required by the FDA that they aren't proven to reduce the risk of heart disease. Lipitor's own claims are very limited.

Next time you hear someone say that a risk factor can double/triple your likelihood of a heart attack, ask what the average risk of heart attack is for someone your age. Hem, haw, stutter, "well, it depends" is what you're likely to get. They won't know. (And no, an average doesn't depend on anything: it's just the percent of people your age who get heart attacks.)

People without cholesterol issues do still have heart attacks, and people with high cholesterol do still live out their lives without major heart disease. Of course, if you die of a heart attack or stroke at age 97, you're a heart disease statistic. If you also had high cholesterol - hah!

C-reactive Protein was ballyhooed for quite a while, but seems to have become muffled since. It's believed to measure the irritability and inflammation level of tissue that may lead to deposits in the arteries. Easing that inflammation may be part of what makes aspirin therapy mildly effective, along with the slipperier platelets. I recently read that it's no longer being rated as being much more accurate an indicator than cholesterol. Of course, that may be because a new drug hasn't been marketed yet that reduces c-reactive protein...

JeffP did make an excellent point, tongue-in-cheek or not, about one study not making something true. This one had the interesting qualities of being from a respected physician and Harvard Medical School educator (and others); being based on very large, accepted studies; and being published in The Lancet, rather than a third-tier advertising journal with a medical-sounding title.

Best wishes,

 

[Rich]

Interesting stuff Bob,

Interesting stuff Bob,

I know you and i have discussed some of this in the past.
Ironically today a doctor suggested my wife switch from Antenolol to Coreg (which I don't think she is going to).
I looked up the drug at drugs.com and sure enough there was the interaction between a beta-blocker and anesthesia. It even suggested farther into the article that this might also include anesthesias used for dental work. Kind of scary.
As far as these cholesterol issues go, I'm still a little confused.
When i was in my early forties, I had a routine physical. My cholesterol was over 300 and my good to bad ratio was extremely bad. My triglycseride level was about 500. The doctor wasn't happy and suggested some changes but as a young (and maybe dumb) guy I never did anything.
About 15 years later it was time for my AVR, so my cardiologist checked me out first. My total cholesterol was 170 ! All the numbers were perfect. And the catherization showed my arteries were totally clean, no plaque, nothing.
How that happened I have no clue.
Rich

 

[Dennis S]

Rich:

Rich:

It sounds like your experience mirrors mine. I am curious if you had a bicuspid aorta valve? My first cardiologist had told me that in his experience my condition was often accompanied by arteries that were totally clean, no plaque, nothing. And that was the case. And he still wanted to put me on Lipitor.

 

[Rich]

Dennis

Dennis

Yes I did have BAV. Replaced it with my St. Jude in the summer of '96.
Still going strong today.
Rich

 

[Jims]

FDA site

FDA site

Tobagotwo,

thanks for the FDA site and the recommendation to report adverse outcomes to them.. I have always wondered how this worked. Your explanation was very good... It is our responsibility!

Jim