MD nixes statin drug

Q: Love your column. Thanks. We have a 70ish-year-old neighbor who has seen a DO who has recommended she stop taking Simvastatin. No blood test to justify this action. She doesn’t remember if the doctor even gave her any reason. Admittedly, this may not either be enough information for your to advise (it may also be too easy, too) or you just plain may need more information about the story but this is what I’ve got. Hope you can advise with an opinion I can show her.

A: Your neighbor was either prescribed Simvastatin because of high cholesterol levels or because of her history of a cardiovascular disorder. Generally speaking, this and other drugs in the same class of meds work well by blocking a substance the body needs to produce cholesterol. Statins may further help the body reabsorb cholesterol’s build up of plaque in arterial walls. There are a number of statins. Some are generic equivalents and more reasonable to purchase but essentially perform the same function. When prescribed because of high cholesterol levels only, it’s because your neighbor has a reading of greater than 200 mg/dL if the LDL is too high.

One difficulty with statin drugs is that an individual cannot discontinue them once their cholesterol levels are lowered to an acceptable range unless major modifications are made for lifestyle changes. For example, if a person were to discontinue eating fried foods, snacks with tropical oils, and other food products high in cholesterol, reduce salt intake, exercise about 30 minutes almost every day of the week, quite smoking, reduce stress and more, he or she might be successful enough to discontinue the drug. Otherwise, the statin or other cholesterol-lowering drug is relatively permanent and must be taken indefinitely on a daily basis.

Then there are the side effects, which is why your neighbor was probably told to go off the drug. While often well-tolerated, statins have been found to cause muscle pain, confusion, memory loss, diarrhea, constipation, weight gain, upper abdominal pain, loss of appetite, insomnia, headache, dark urine, pain on urination, and nausea. While rare, the use of statins can cause liver damage. A person on a drug in this category must have periodic blood testing to determine if the liver is affected and if the drug should be discontinued. I must add here that while research is ongoing, the FDA issued a statement carried by the Wall Street Journal on February 29, 2012, warning that patients taking cholesterol-fighting statins face a small increase in the risk of higher blood sugar levels and being diagnosed with diabetes. At the time, the warning wasn’t expected to suggest to doctors they discontinue prescribing statins for patients with multiple risk factors for heart attack, and indicated cardiologists feel the benefits of statins still outweigh the risks. The FDA announced drug makers could remove label warnings that lab testing should be monitored during statin therapy, stating serious liver injury with statins is rare and unpredictable, that periodic monitoring didn’t appear effective in detecting or preventing the rare side effect. Numerous studies ensued (including one with over 90,000 patients) published in the Lancet in 2010. The conclusion was that statin therapy is associated with a minimally increased risk of development of type II diabetes. In terms of the breakdown of muscle cells, – a condition known as rhabdomyolysis that can release the protein myoglobin into the bloodstream, the study also found the risk to be low. Specific drugs include Lopid, Restasis, Sandimmune, Niacor, Niaspan, and anti-fungal meds taken in conjunction are a risk for elevated glucose levels, type II diabetes, memory loss and confusion; fortunately, it appears the memory loss and confusion will disappear if the statin is discontinued.

One option is to consider an over-the-counter cholesterol lowering drug such as niacin or Cholest-Off and similar products that contain plant sterols and stanols; however, your friend should run these options past her physician first.

Oh, the flush of some medications

Q: I battle high cholesterol. Niacin makes me flush. I have found a flush-free niacin, inositol hexanicotinate. Is this really niacin and what have you heard about its effectiveness in helping to lower bad cholesterol?

A: To begin with, the regular use of niacin can be preceded by either diphenhydramine (Benadryl) or aspirin that will prevent the flushing aspect that is so difficult for patients to deal with. However, I strongly urge you to speak with your primary care physician before putting this into play because of an anti-coagulant issue that could present problems for some individuals.

Inositol hexanicotinate is used for a variety of conditions to include hypertension, insomnia, atherosclerosis, restless legs syndrome, poor circulation, Raynaud’s disease, high cholesterol levels, and more. It is a compound of niacin (vitamin B3) and inositol. This form of niacin is purported to reduce or prevent flushing, simply because it breaks down at a slower rate. Inositol hexanicotinate appears safe for most individuals, works to reduce cholesterol levels in some people but the results of tests are contradictory. [Read more…]

Oat bran and psyllium for cholesterol

Q: In 1986 I had a heart attack. Among other drugs I was put on 10 mg of Lipitor. I took that for many years. Then I read and heard about oat bran and decided to try it. I ordered 1000 mg oat bran tablets from a catalog. Around the same time, my gastroenterologist also urged me to get more fiber in my diet so I also ordered 560 mg psyllium capsules. I take one oat bran tablet twice a day and one psyllium at bedtime. I had a routine blood lab test following starting these supplements and my doctor indicated that he thought my cholesterol level was too low and had me reduce my Lipitor to 5 mg daily.

For some years now I have taken the oat bran and psyllium and my cholesterol has remained low with the “good” cholesterol being “ideal”. I don’t like to take drugs, and recently reduced my Lipitor to 5 mg every other day. On my next blood work test next month, I will find out my new count. I’d much rather take the oat bran and psyllium than the Lipitor.
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Is a statin really necessary?

DEAR DR. GOTT: I am a 73-year-old white male, non-smoker, in what I think is good health. Shortly after my birthday a few months ago I decided to find a cardiologist so when/if I had a heart attack, he would have my information.

My overall cholesterol was 152 with my HDL being low at 33. Triglycerides 155. All other blood work was normal. After the initial interview, I had a stress test which I failed because I only lasted a bit over four minutes. No shortness of breath, no chest pain, no discomfort other than my legs got tired. Also, an EKG was done which showed something abnormal, but he said “no event”. He then scheduled me for a heart cath which I had done. The results showed a 10% blockage throughout my system. He said because I had three risk factors – mother died of a heart attack at 85 after a lifetime of smoking, my BMI is 26 and my HDL was low, he prescribed Zocor 2 mg. I am reluctant to start a cholesterol lowering drug unless it is necessary. I would like your thoughts on this.
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Doc recommends a statin

DEAR DR. GOTT: I’m diagnosed with von Willebrand’s type 2B bleeding disorder. My doctor wants to put me on cholesterol medication and my cholesterol to be under 70. I’m 60 years old.

I’m terrified of statin side effects and wonder why doctors push so hard to prescribe statin meds.

DEAR READER: VonWillebrand’s results from a deficiency in or impairment of a protein in the blood clotting process. Essentially, those with the condition will take longer to stop bleeding when they are cut and longer than normal to form clots. This can occur during a particularly heavy menstrual flow, from bleeding of the gums following tooth brushing, a razor cut, nosebleed, tooth extraction, and countless other conditions that occur every day.
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Oat bran for cholesterol

DEAR DR. GOTT: I am a 67-year-old female that has been taking pravastatin 20 mg for high cholesterol. I have been on this medication for about 3 years. I recently read an article from a French medical doctor who was recommending oat bran as a way of cutting down bad cholesterol.

Oat bran is the hull of the oats we normally eat. It can be purchased from health food stores across the states or online so I got some and started incorporating the normal two tablespoons into my daily diet. After two weeks of this in my diet, I had a blood test run by my cardiologist. When I went in for my exam, the doctor almost dropped his teeth. My triglycerides had dropped from 209 the previous exam 7 months earlier to 128. My HDL went from 41 to 38 and my AST went from 42 to 27. With results like this I felt I needed to share with others in the same fix.
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High cholesterol levels frustrating to control

DEAR DR. GOTT: I am so confused! I am a 47-year-old female, 5’5” tall, 128 pounds, pre-menopausal. My hypothyroidism is managed by Synthroid 25 mcg per day. Also, I have a vitamin D deficiency managed by 50000 units per week. I do not eat any red meat, exercise at least 30 minutes per day (breaking a light sweat through using a stationary bike at 15-16 mph).

I eat a balanced diet consisting of beans and legumes for protein and I cook with olive oil and other “good” fats. I consume two to three ounces of red wine with dinner nightly. Despite all this, my cholesterol is 221 and my triglycerides are 195. My HDL is 59 (I worked hard to raise it from 50) and my LDL is 123. I am dumbfounded! How can I lower my cholesterol and triglycerides further? Also, the lab collected blood after a 5 hour fast only and they did not instruct me to abstain from alcohol [Read more…]

Is red rice yeast good for lowering cholesterol?

DEAR DR. GOTT: Does red yeast rice actually help to lower cholesterol and what can the adverse side effects be?

DEAR READER: Let me take a moment to explain to readers just what the product is before I attempt to answer your question. Red yeast rice is actually rice fermented with Monascus purpureus. It contains several compounds that together are known as monacolins, known to inhibit the formation of cholesterol and which may lower cholesterol levels. Red yeast has a similar chemical make-up to that of lovastatin (Mevacor) and certain other statin drugs and therefore may carry similar side effects.
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Side effects linked with cholesterol medications

DEAR DR. GOTT: I read your article about statin drugs and their side effects. I have been on cholesterol medication for the last couple of years. The side effects are killing me — pain in both of my forearm muscles, calf muscles, and numbness in my fingers. The medicines I was on causing the same side effects were pravastatin 20 mg and simvastatin 20 mg.

My doctor suggested I reduce the dosage to 10 mg and then to 5, which hasn’t stopped my pain. He currently has me on Lipitor/atorvastatin 5 mg, but the problem persists. My recent lipid panel showed the following: cholesterol 172 HDL 33; LDL 105, triglycerides 177 and A1C 6.7.

These drugs are not cheap. I can’t keep trying this and trying that, so what should I do?
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Understanding cholesterol numbers

DEAR DR. GOTT: I am a 59-year-old female, about 145 pounds (I should be 135). For about 10 years, I have eaten no mammal meat, have excluded milk and dairy from my diet, and have avoided shellfish. I start each day with a bowl of cooked oat bran with soy milk. I average more than 30 grams of soluble and insoluble fiber per day. I eat salmon, tuna and a little poultry. I exercise vigorously at least three times a week and wear a heart monitor so I get at least 25 minutes in the 75- to 90-percent maximum zone. My blood pressure averages 102/58.

My first cholesterol test when I was in my 20s was over 250. All subsequent tests have been between 230 and 260. My HDL is always over 80, often over 100. My LDL varies from low to borderline, and my triglycerides are usually low.
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