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tim1028 (@tim1028)

Statin Intolerance

Heart & Blood Health | Last Active: Aug 31, 2019 | Replies (18)

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Hi @cindyt63,

There is no denying that many of the statin trials are funded by pharmaceutical companies, but it does raise the question if we are seeing the whole picture.
I thought it might help to post a few key notes from the most recent guidelines, (ACC/AHA), which emphasize that having high cholesterol “at any age” significantly increases the risk of cardiovascular disease. http://www.onlinejacc.org/content/73/24/e285?_ga=2.18947835.275792085.1564661742-2093008911.1564661742

– There is now a class I indication for reducing LDL cholesterol levels by 50% or more with a high-intensity statin (atorvastatin 40-80 mg and rosuvastatin 20-40 mg), or a maximally tolerated statin dose, in all patients with clinical atherosclerotic cardiovascular disease (ASCVD).

– For ASCVD patients at very high risk, such as those with a history of multiple events or one major ASCVD event and multiple high-risk conditions—and with LDL cholesterol ≥ 70 mg/dL—the guidelines recommend adding ezetimibe to maximally tolerated statin therapy in order to lower LDL levels.
If LDL still remains ≥ 70 mg/dL, adding a PCSK9 inhibitor such as alirocumab (Praluent; Regeneron/Sanofi) or evolocumab (Repatha; Amgen) is reasonable although the long-term safely of PCSK9 inhibitors is unknown.

– In the patient 40 to 75 years with diabetes, the guidelines recommend starting treatment with a moderate-intensity statin without assessing the 10-year risk of ASCVD (class I). If the diabetic patient has multiple high-risk features, or is 50 to 75 years old, consider using a high-intensity statin.

– For the first time, the new guideline also includes a Value Statement that underscores the need for clinicians and patients to factor in the cost of drugs in determining the most appropriate treatment rates.

With regard to Repatha (thanks for the suggestion), it is more often used to treat patients with heterozygous familial hypercholesterolemia, or with homozygous familial hypercholesterolemia (HoFH), who need additional lowering of their LDL cholesterol. https://www.mayoclinic.org/drugs-supplements/evolocumab-subcutaneous-route/side-effects/drg-20152627?p=1
Unfortunately, the cost of this drug (and others in the same class) is prohibitive – which is why the new guideline about statins includes a Value Statement.

I certainly don’t mean to inundate you with more reading:) but I’m hoping this article might shed some more light on the statin debate:
"AHA’s Statement on the Safety Profile of Statins: Big Benefit with Low Risk” https://professional.heart.org/professional/ScienceNews/UCM_503181_AHAs-Statement-on-the-Safety-Profile-of-Statins-Big-Benefit-with-Low-Risk.jsp

The treatment for high cholesterol is not one size fits all, and I wish we could get a conclusive answer. But it’s absolutely okay to question and disagree –as long as we do it in a way that is based in science. I hope to hear more from you and fellow Connect members – continue to further the conversation.

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Replies to "Hi @cindyt63, There is no denying that many of the statin trials are funded by pharmaceutical..."

Having ruled out four of the six statins available because my reaction to them is muscle pain that is debilitating, I have to ask what am I to do? If I never saw another statin I would be happy but there are all those studies that say they are necessary. I am 74 and had a heart attack in January of 2016. At that time my cholesterol was within normal range but each time I have taken statins, upon cessation of the drug (after taking them for 4-8 months) I see a definite increase in numbers above what they were when I started. My question would be does taking the statin which reduces my cholesterol, alter the normal function of my body artificially increasing numbers. The idea that anyone should live in pain to take this medication should be unacceptable to any patient and their doctor but I am fearful that not taking them will somehow kill me. Can the alternatives be taken effectively without a statin? The class such as Repatha et.al are very expensive… Any suggestions?

Thank you backing up the importance of statins. In my family we have a genetic disorder which causes us to have super high cholesterol despite eating a healthy diet. It has been the killer on my mom's side. My cholesterol is over 300 and that's after months if Lipitor. So Cardiologist doubled my dose. Yes, I get the "muscle" pain but I already deal with extreme chronic pain anyway and take meds for it so…I'm a lil tougher than that and will deal with it so I do not have a 4th heart attack.
Just my opinion but I'm less likely to take my cardiovascular health into my own hands based on numbers I took off the internet. And I would certainly be doubtful of a Dr whom agreed. I have a pacemaker and received diagnosis of DVT this week.
I will add the COQ10 to my regimen though. Thanks for the tip.
Listen to your Drs folks. Stay knowledgeable but don't second guess your Drs based on the internet. It could be the difference between life and death! This is your CARDIOVASCULAR HEALTH not a common cold.❤

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