Statin alternatives for coronary artery blockage

Posted by frankad @frankad, Aug 24, 2016

I had a catheter ablation procedure in Jan 2016 for A-fib and am currently doing fine and am off of metoprolol and eliquis. Based on a CAT scan of Nov 2015 which found some blockage in my coronary artery, my cardiologist recommends I take a statin medication, thought my cholesterol, HDL/LDL, triglycerides, and platelet counts all seem to be in the good to low range, and I exercise regularly. I've read much about taking statins for high cholesterol, but not much about taking statins for coronary artery blockage, or of what help statins might be for that condition. I'm resistant at this point to taking a statin medication having read or heard about the side effects. I would appreciate any feedback you might have to offer, and what supplements might be of benefit.

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@frankad

Thank you so much for your reply and feedback on the use of statins. I turned 69 this past June, six months after my ablation procedure. My electrophysiologist, in New York, where I had the procedure kept me on eliquis for six months following the procedure but I was allowed to stop taking the metoprolol immediately after the procedure. I asked to be allowed to stop taking the anticoagulation drug in June during my follow up visit and was approved. The physician did not offer a counter argument so I felt safe in doing so. I'm averse to taking any kind of medication as I've been healthy most of my life, and I worry about side effects. My new cardiologist here in Las Vegas, where I live now has recommended that I take statins, but I worry about the side effects and the impact it will have on my physical abilities to exercise and enjoy life at my current level. The metoprolol slowed me down tremendously when I tried to exercise and I don't want to go back to that. Also, I've not been given a complete picture of exactly how much blockage, or how many arteries are affected by blockage. I'm told that I would need to have an Angioplasty procedure to determine exactly how much blockage there is. So why did I have to have a CAT scan taken with all of the radiation one is exposed to? I have a bit of a communication problem with my new cardiologist here in Las Vegas, which makes me even more hesitant to do everything that he recommends. I do appreciate your feedback very much, and am still in the process of trying to decide what to do. Please forward any new information you might come across to me as I appreciate all the advice I can get at this point. Life is not without risk, but I don't want to make a fatal mistake either. Thanks again.

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your last sentence is very important. as to me, i' am in the same situation, shall I go on with the oral anticoagulation (Xarelto) and have a risk for internal bleeding (mostly gastrointestinal), or shall I stop? several cardiologists said to me, why do you bother? you are with Xarelto on the safe side.you can travel everywhere, A-Fibs can't cause a cerebral thrombosis anymore.that was one of the reason,why I decided to have a mitralvalve repair (my A-Fibs started after a deterioration of the mitral regurgitation,from stage I to II).the underlying disease was a mitral valve prolaps.I thought ,wenn the repair and the ablation are successful, and the heart function goes back to normal, there is no need for medication like b-blocking agents and oral anticoagulation anymore.but doctors don't care about the high prices, they simply don't want to be blamed, if the patient suffers from a stroke.
As to statins, as I wrote, I have been taking statins (simvastatin 20 mg) for a long time. nearly all my family members have a high cholesterol level and take statins. I'm lucky,as my cholesterol level is only slightly increased and my HDL is high (unusual).a medication with statins was not really necessary, but my younger sister had a heart attack,wenn she was 52 and got two stents in her coronary arteries.so in my case it is a profylactic administration.and I will continue it. I have no problems, no muscle aching for example. my younger brother needs 40 mg simvastatin and he goes jogging. to avoid any muscle problems he skips the statin every sunday.(he is a biochemist).
I shouldn't worry about possible side effects.niacin was used a long time ago, the introduction of the statins changed everything.
I think that eating habits are very important, especially which oil you use. I never use butter or margarine, for baking olive oil. we are lucky, as we can buy olive oil directly from the producer in greece. there is no possibility for the owner to manipulate the oil, as we stand beside..

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@yoanne

according to the guidelines in germany/europe a statin therapy is a MUST in your case, if there are deposits/plaques in the coronary arteries. the aim of the treatment is a LDL-value beneath 100, if possible beneath 70.,on condition that you can tolerate the medication. it is quite interesting to read,that you were allowed to stop the oral anticoagulation (and the metropolol) after the ablation. as I already wrote in this forum, I had a mitralvalve repair, together with a surgical ablation around the pulmonal veins. yesterday I visited my cardiologist for a check (4 months after the operation).mitral valve function is excellent, so far I had no A-Fib. I had a discussion with him about my suggestion to stop the Xarelto treatment. He didn't like the idea. his advice is to continue , because the recurrence rate of A-Fib is high and I may not notice it, for example during the night. moreover I remain a "high-risk" patient because of my age (70) and I am a woman. of course I can decide to stop Xarelto, , but this a very difficult decision. you didn't mention your age .if you are young, maybe there is a different opinion.
(by the way, I take also a statin,although my arteries are completely free, even the coronary arteries).

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to be able to answer your question, I need to know, if you are suffering from a mitral valve prolapse, which causes a degenerative or primary mitral regurgitation (not identical with a functional or secundaire mitral regurgitation)

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@frankad

Thank you so much for your reply and feedback on the use of statins. I turned 69 this past June, six months after my ablation procedure. My electrophysiologist, in New York, where I had the procedure kept me on eliquis for six months following the procedure but I was allowed to stop taking the metoprolol immediately after the procedure. I asked to be allowed to stop taking the anticoagulation drug in June during my follow up visit and was approved. The physician did not offer a counter argument so I felt safe in doing so. I'm averse to taking any kind of medication as I've been healthy most of my life, and I worry about side effects. My new cardiologist here in Las Vegas, where I live now has recommended that I take statins, but I worry about the side effects and the impact it will have on my physical abilities to exercise and enjoy life at my current level. The metoprolol slowed me down tremendously when I tried to exercise and I don't want to go back to that. Also, I've not been given a complete picture of exactly how much blockage, or how many arteries are affected by blockage. I'm told that I would need to have an Angioplasty procedure to determine exactly how much blockage there is. So why did I have to have a CAT scan taken with all of the radiation one is exposed to? I have a bit of a communication problem with my new cardiologist here in Las Vegas, which makes me even more hesitant to do everything that he recommends. I do appreciate your feedback very much, and am still in the process of trying to decide what to do. Please forward any new information you might come across to me as I appreciate all the advice I can get at this point. Life is not without risk, but I don't want to make a fatal mistake either. Thanks again.

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@yoanne, your analysis and the information you have collected make it clear that you're a whiz at managing your own medical condition, and your use of multiple cardiologists at one time or another shows that you are double-checking what you are told by medical professionals. Kudos to you!

As to Xarelto versus Coumadin, note that emergency rooms stock a Coumadin antidote (vitamin K solution) that cancels the anticoagulation effect of Coumadin in 10-20 minutes. An antidote for Xarelto is in development, but isn't yet ready for distribution beyond its research laboratory. My cardiologists recommended and prescribed Coumadin to ensure immediate availability of an antidote. However, I don't have a gastro problem like yours, which could bring different advice from my medical team.

As to statins, am I correct in assuming that you are taking a relatively low dose once a day? If so, you are not likely to notice any recent forgetfulness or clumsiness which a statin may provoke. That was a problem for me, so my primary physician looked at my diet and exercise regimen and suggested that it is good enough -- in light of good lab results -- to warrant dropping the statin medication.

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@yoanne

according to the guidelines in germany/europe a statin therapy is a MUST in your case, if there are deposits/plaques in the coronary arteries. the aim of the treatment is a LDL-value beneath 100, if possible beneath 70.,on condition that you can tolerate the medication. it is quite interesting to read,that you were allowed to stop the oral anticoagulation (and the metropolol) after the ablation. as I already wrote in this forum, I had a mitralvalve repair, together with a surgical ablation around the pulmonal veins. yesterday I visited my cardiologist for a check (4 months after the operation).mitral valve function is excellent, so far I had no A-Fib. I had a discussion with him about my suggestion to stop the Xarelto treatment. He didn't like the idea. his advice is to continue , because the recurrence rate of A-Fib is high and I may not notice it, for example during the night. moreover I remain a "high-risk" patient because of my age (70) and I am a woman. of course I can decide to stop Xarelto, , but this a very difficult decision. you didn't mention your age .if you are young, maybe there is a different opinion.
(by the way, I take also a statin,although my arteries are completely free, even the coronary arteries).

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please, read my post of today, August 28 /mitral valve repair. it might help you!

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@frankad

Thank you so much for your reply and feedback on the use of statins. I turned 69 this past June, six months after my ablation procedure. My electrophysiologist, in New York, where I had the procedure kept me on eliquis for six months following the procedure but I was allowed to stop taking the metoprolol immediately after the procedure. I asked to be allowed to stop taking the anticoagulation drug in June during my follow up visit and was approved. The physician did not offer a counter argument so I felt safe in doing so. I'm averse to taking any kind of medication as I've been healthy most of my life, and I worry about side effects. My new cardiologist here in Las Vegas, where I live now has recommended that I take statins, but I worry about the side effects and the impact it will have on my physical abilities to exercise and enjoy life at my current level. The metoprolol slowed me down tremendously when I tried to exercise and I don't want to go back to that. Also, I've not been given a complete picture of exactly how much blockage, or how many arteries are affected by blockage. I'm told that I would need to have an Angioplasty procedure to determine exactly how much blockage there is. So why did I have to have a CAT scan taken with all of the radiation one is exposed to? I have a bit of a communication problem with my new cardiologist here in Las Vegas, which makes me even more hesitant to do everything that he recommends. I do appreciate your feedback very much, and am still in the process of trying to decide what to do. Please forward any new information you might come across to me as I appreciate all the advice I can get at this point. Life is not without risk, but I don't want to make a fatal mistake either. Thanks again.

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Hi predictable,

Actually, I've not started taking any statins at this point. My cardio guy here in Las Vegas is not happy with me about that, but I don't believe that doctor's look at individual cases as compared to the large statistical profiles that they're informed about. Thanks again for the comeback. Also, I'm getting a little confused about recognizing exactly who's talking to me as there seem to be multiple conversations going on at this site, so please send any comments to, Frankad, so that I'm sure it's me that's being addressed. Thanks

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@frankad

Thank you so much for your reply and feedback on the use of statins. I turned 69 this past June, six months after my ablation procedure. My electrophysiologist, in New York, where I had the procedure kept me on eliquis for six months following the procedure but I was allowed to stop taking the metoprolol immediately after the procedure. I asked to be allowed to stop taking the anticoagulation drug in June during my follow up visit and was approved. The physician did not offer a counter argument so I felt safe in doing so. I'm averse to taking any kind of medication as I've been healthy most of my life, and I worry about side effects. My new cardiologist here in Las Vegas, where I live now has recommended that I take statins, but I worry about the side effects and the impact it will have on my physical abilities to exercise and enjoy life at my current level. The metoprolol slowed me down tremendously when I tried to exercise and I don't want to go back to that. Also, I've not been given a complete picture of exactly how much blockage, or how many arteries are affected by blockage. I'm told that I would need to have an Angioplasty procedure to determine exactly how much blockage there is. So why did I have to have a CAT scan taken with all of the radiation one is exposed to? I have a bit of a communication problem with my new cardiologist here in Las Vegas, which makes me even more hesitant to do everything that he recommends. I do appreciate your feedback very much, and am still in the process of trying to decide what to do. Please forward any new information you might come across to me as I appreciate all the advice I can get at this point. Life is not without risk, but I don't want to make a fatal mistake either. Thanks again.

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@frankad, I try to include the name of the member I'm addressing in my message, as you do. Sometimes I forget. There are others who never do that, and that confuses me no end. But eventually the truth prevails. Waiting for it can be painful, though.

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Thanks predictable, look forward to hearing from you again. Frankad

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@frankad

Thank you so much for your reply and feedback on the use of statins. I turned 69 this past June, six months after my ablation procedure. My electrophysiologist, in New York, where I had the procedure kept me on eliquis for six months following the procedure but I was allowed to stop taking the metoprolol immediately after the procedure. I asked to be allowed to stop taking the anticoagulation drug in June during my follow up visit and was approved. The physician did not offer a counter argument so I felt safe in doing so. I'm averse to taking any kind of medication as I've been healthy most of my life, and I worry about side effects. My new cardiologist here in Las Vegas, where I live now has recommended that I take statins, but I worry about the side effects and the impact it will have on my physical abilities to exercise and enjoy life at my current level. The metoprolol slowed me down tremendously when I tried to exercise and I don't want to go back to that. Also, I've not been given a complete picture of exactly how much blockage, or how many arteries are affected by blockage. I'm told that I would need to have an Angioplasty procedure to determine exactly how much blockage there is. So why did I have to have a CAT scan taken with all of the radiation one is exposed to? I have a bit of a communication problem with my new cardiologist here in Las Vegas, which makes me even more hesitant to do everything that he recommends. I do appreciate your feedback very much, and am still in the process of trying to decide what to do. Please forward any new information you might come across to me as I appreciate all the advice I can get at this point. Life is not without risk, but I don't want to make a fatal mistake either. Thanks again.

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@predictable, of course, we should mention the name. I got irritated as well, but did not correct my mistake, sorry!
I know about the failing antidote for Xarelto, but the doctors here, especially in the emergency department, know what to do. 5 years ago my cardiologist said to me, because of your age you need an oral antigoalation in stead of 100 mg aspirin. he asked me, what do you want, Coumadin or one of the new OAG's,like Xarelto.? I said, I prefer the new one, because I didn't want the monitoring, necessary for Coumadin, as you know. so he gave me a perscription. He informed my general practitioner.but she did not agree, because this medicine is very expensive (98 tablets Xarelto 320 Euro) and she would have problems with the insurance company. (in germany every doctor has a medicine budget for 3 months, in total for all the patients she sees. the budget is lower for a family doctor, higher for a cardiologist. she would only perscribe Coumadin, which I refused. we got an unpleasant quarrel, and I had to find another family doctor, I tolerate Xarelto very good, no gastrointestinal bleeding so far.the only problem is , that I easily bleed. Januar last year I had an accident with the bicycle, my small finger was injured (no open injuries, but a big swelling around , definitely blood).6 months later a X-ray showed a fracture, too late for a treatment. and the other disadvantage of Xarelto is that I cannot take all kinds of pain drugs, only paracetamol is allowed, no aspirin etc.
My daily dosage for simvastatin is low, 20 mg (sometimes only 10 mg, alternating).

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@frankad

Thank you so much for your reply and feedback on the use of statins. I turned 69 this past June, six months after my ablation procedure. My electrophysiologist, in New York, where I had the procedure kept me on eliquis for six months following the procedure but I was allowed to stop taking the metoprolol immediately after the procedure. I asked to be allowed to stop taking the anticoagulation drug in June during my follow up visit and was approved. The physician did not offer a counter argument so I felt safe in doing so. I'm averse to taking any kind of medication as I've been healthy most of my life, and I worry about side effects. My new cardiologist here in Las Vegas, where I live now has recommended that I take statins, but I worry about the side effects and the impact it will have on my physical abilities to exercise and enjoy life at my current level. The metoprolol slowed me down tremendously when I tried to exercise and I don't want to go back to that. Also, I've not been given a complete picture of exactly how much blockage, or how many arteries are affected by blockage. I'm told that I would need to have an Angioplasty procedure to determine exactly how much blockage there is. So why did I have to have a CAT scan taken with all of the radiation one is exposed to? I have a bit of a communication problem with my new cardiologist here in Las Vegas, which makes me even more hesitant to do everything that he recommends. I do appreciate your feedback very much, and am still in the process of trying to decide what to do. Please forward any new information you might come across to me as I appreciate all the advice I can get at this point. Life is not without risk, but I don't want to make a fatal mistake either. Thanks again.

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@yoanne, I have been on Coumadin for over two years. My HMO has a pharmacist tracking me regularly to check on my anticoagulation rating. He schedules a monthly laboratory test to keep on top of it; I drop in on the way to or from the bowling alley on Tuesday. He reminds me how lifestyle and diet choices could change it. So far, no problem. An 83-year-old friend has been on Coumadin for 10 years. His dose is small (compared with mine) and he monitors his coagulation level at home with an inexpensive device. You may need a similarly small dose of Coumadin, given your doctor's advice to move up from aspirin.

A year ago, a neighbor and friend fell off a step-ladder in his garage. I found him bleeding on the floor and got an ambulance to take him to the emergency room a mile away. The ER had no antidote for his anticoagulation drug, so they helicoptered him to a hospital 30 miles and 45 minutes away. He never recovered from the brain bleed, dying within hours, fortunately with family around him although they couldn't get a response from him.

I resolved to stay with Coumadin so long as it's the only anticoagulant for which there is a stock antidote (an antidote for Xarelto is in development, but is not yet released to put in stock). Saves me a lot of anxiety as well as a lot of money!

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@frankad

Thank you so much for your reply and feedback on the use of statins. I turned 69 this past June, six months after my ablation procedure. My electrophysiologist, in New York, where I had the procedure kept me on eliquis for six months following the procedure but I was allowed to stop taking the metoprolol immediately after the procedure. I asked to be allowed to stop taking the anticoagulation drug in June during my follow up visit and was approved. The physician did not offer a counter argument so I felt safe in doing so. I'm averse to taking any kind of medication as I've been healthy most of my life, and I worry about side effects. My new cardiologist here in Las Vegas, where I live now has recommended that I take statins, but I worry about the side effects and the impact it will have on my physical abilities to exercise and enjoy life at my current level. The metoprolol slowed me down tremendously when I tried to exercise and I don't want to go back to that. Also, I've not been given a complete picture of exactly how much blockage, or how many arteries are affected by blockage. I'm told that I would need to have an Angioplasty procedure to determine exactly how much blockage there is. So why did I have to have a CAT scan taken with all of the radiation one is exposed to? I have a bit of a communication problem with my new cardiologist here in Las Vegas, which makes me even more hesitant to do everything that he recommends. I do appreciate your feedback very much, and am still in the process of trying to decide what to do. Please forward any new information you might come across to me as I appreciate all the advice I can get at this point. Life is not without risk, but I don't want to make a fatal mistake either. Thanks again.

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@predictable hello!
you did not mention,which anticoagulation drug your neighbour took. but probably one of the new ones. any person in the ER should know what to do,,especially since there is no antidote. (information about the treatment of bleeding has been included in the patient leaflet, for example bayer/xarelto.(I cannot send it to you, as it is written in german) . yesterday I read an article (very recently) about Vit.K antagonists and the new Anticoagulation drugs.
https://www.drugwatch.com/xarelto/vs-warfarin/
bleeding is a problem for both ,cerebral bleeding a big problem., with warfarin even bigger than with Xarelto. most people do not survive. I' m aware of this problem, it means risk or benefit, I have to believe the cardiologists.
concerning warfarin/coumadin I'm not positive. the reason is the medical history of my oldest brother. he was suffering form heart failure. since 10 years he took coumadin, and he was monitored by a special service in amsterdam (a nurse visited him at home).2009 he needed a cardioverter. the implantation was done in the university hospital of amsterdam.24 hours later he left the hospital, 12 hours later he died. - cause of death:cerebral bleeding and lung embolism. obviously the warfarin monitoring was not correct during and after his stay in the hospital. you can imagine that we were very shocked. since then I'm not keen on taking Vit.K antagonists.

I regret that the cardiac surgeon did not perform the left atrial appendage closure. this is up to now not a standard procedure, but my cardiac surgeon told me, that it will soon be done by all patients, who have preoperative A-Fib. ,like me. I'm quite sure,that this item will be discussed by the american and european societies of cardiology. Had it be done, I would not need any anticoagulation.

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