Cardiovascular Disease Prevention Expert Forum
Changing statin and other regimens
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Questions in the Cardiovascular Disease Prevention forum are answered by Dr. Lee Kirksey, associate professor at The University of Pennsylvania School of Medicine.

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Changing statin and other regimens

Hello

HISTORY: 2002 Angioplasty for 70 percent blocakge in one artery using catheritization (arm, Dr. Saito in Japan). No stent.
2006 Re-did angioplasty and no restenosis.
2008 Did CT scan but taking radiactive dye and also no restenosis.
Age: 56
Regimen: Lipitor 5 mg, baby aspirin, fish oil (about 3-4 grams). Some doctor gave me all EPA (Japanese brand) but other Dr. recommended  EPA/DHA. I take both, totally above 3-4 grams)
Food-one glass red wine most evenings, olive or canola mainly
I also take some drugs for prior ulcer-proton pump inhibitor, gastric lining coating, and asthma (singulair and flotide)


Salt- Have always used very little (for japan, which is high anyway and most people get at least 10 g a day.  Since May my Japanese nurse girlfriend has cooked, but she uses salt whereas I never did.

Asthma Dr. said that he would consider changing from Lipitor 5 mg to Crestor (dosage not yet mentioned) after 1 more blood test. Long time ago, cardiologist said no need to change when another MD suggested. (I think Crestor has big marketing push)

Last results in Augst:
Triglycerides 89 (lowest)
HDL  51 (used to be 68)
LDL  86 (lowest yet)
CK protein  290 (where normal is 40-180). Cardiol. said before ok if no pain.
ALT 29.8 where normal is -25
AST--28 where normal is 10- 30)

Blood pressure varies.  Before 127/75. Now it varies from 139/86 to 120/85 to errors (when I get nervous the machine in the gym gives odd results).  But in general, the bottom figure seems a bit higher whereas the top figure fluctuates. Could be I am nervous when measuring....

My weight down  5-8 pounds SINCE August (when blood test was done). Another was done yesterday.

QUESTIONS
I am confused by what effects what.  What I should consider doing more or less of.  In other words, where I could put more effort.
Wine, Olive/Canola--> LDL? HDL?
Fish oil--> trigs?
Statin--> LDL? Trigs?
Exercise- HDL?
Statin-How to evaluate whether changing from lipitor to crestor would be worthwhile.
THANKS
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469720_tn?1388149949
Hello
Conratulations on your attention to lifestyle changes. Its obvious that your doing everything possible to prevent progression of coronary artery disease
A couple recommendations:
To help decrease triglycerides, you can fish oil and niacin or niaspan.
To help increase HDL, you can exercise more, fish oil, fiber,
To help decrease LDL, either crestor or lipitor will work; You are in a good range and would not go up on this any more. Add Co Q 10 300mg to your regimen because you use a statin.  

By far, diet is the most important change that you can make. A low total fat with less than 30 gm per day and less than 12gm saturated fat has been shown to actually make blockages regress with time

For more information, I would encourage you to consider my book, Your Guide to Optimal Health. www.personalwellnesswheel.com

Good luck
3 Comments
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Avatar_n_tn
I appreciate your comment.  However, one point is vague.  I said that though my CK is elevated I have NO muscle pain. I do not see anything here or in the cardilogy forum that indicates research shows COQ 10 is needed UNLESS there are side effects.  So why do you recommend them?    I appreciate your offer to read your book, but I would hope that your professional opinion could be explained without my having to buy a book.  That is why I paid the fee to get an answer. In addition, a heart forum on about.com answering a similar questions says nothing about any conclusive evidence that COQ10 is indicated.

Thanks.
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469720_tn?1388149949
Supplementing with Coenzyme Q10 has been shown in studies to decrease blood pressure slightly in those with high blood pressure. It has also been studied for slowing dementia, and reducing angina, symptoms associated with heart failure and other symptoms associated with heart -related illnesses.

I recommend Coen Q10 to all patients with cardiac disease regardless of the presence of myopathy, because I have seen significant benefit in my practice patients.

The safety profile is very good.  No large, prospective randomized trials have been done to assess its overall benefit and there will likely be none since trials of that nature are quite expensive and no pharmaceutical company would invest that amount of money for the minimal return on an agent like Co Q10.

A search and review at pubmed will provide you with all of the available medical research evidence on Co Q10 and Dr Stephen Sinatra has written an entire book on this agent. Best of luck

http://www.mhprofessional.com/product.php?isbn=0879839570&cat=&promocode=
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