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Agonizing over taking statins!
I am a 47 year old female, 5'8" and apprx. 180#. No current meds except Climara for estrogen replacement(had a hysterectomy in '96). Do a little light walking every day, but currently do not have a regular work-out routine. Sometimes I feel some chest pressure and lightheadedness upon exertion, but not sure if this is because I am out of shape, or because I may have some CAD brewing. One month ago,I had a a lot of lab work done by my PCP.
My initial reason for visiting the doctor, was because I was having symptoms that were similar to those related to diabetes or thyroid problems. Most all of my labs were "WNL" except my cholesterol, which was 278. My HDL, HDL/Cholsterol ratio and triglycerides were normal, but LDL is 204.
I have had two physicians strongly encourage taking a statin. The second physician was my gyn, who I saw last week for my annual woman exam. Doc #1 gave me an Rx for Mevachor/lovastatin 20 mg. Doc #2 gave me 2 weeks of 5mg. Crestor and told me to start on them right now and then if all was going well when he sees me again in a couple of weeks, he'll give me an Rx.
I have yet to take a pill because I am very scared of side effects. My body is so sensitive to many medications and I have done a lot of research on statins and am terrified!
Part of me is rationalizing that because my other lipids are normal, that it will "balance out" the crummy LDL. I'm probalby fooling myself, but I can't get past the fear of a bad reaction.
My diet isn't perfect, but I am making big efforts to eat healthier. I know the increased exercise will help too.
Neither doc thinks my high LDL can be lowered to an acceptable level with diet and exercise alone.
I want to do the right thing, but my fear is so great!
Is this my gut telling me to not take statins, or am I working myself up unnecessarily?
My initial reason for visiting the doctor, was because I was having symptoms that were similar to those related to diabetes or thyroid problems. Most all of my labs were "WNL" except my cholesterol, which was 278. My HDL, HDL/Cholsterol ratio and triglycerides were normal, but LDL is 204.
I have had two physicians strongly encourage taking a statin. The second physician was my gyn, who I saw last week for my annual woman exam. Doc #1 gave me an Rx for Mevachor/lovastatin 20 mg. Doc #2 gave me 2 weeks of 5mg. Crestor and told me to start on them right now and then if all was going well when he sees me again in a couple of weeks, he'll give me an Rx.
I have yet to take a pill because I am very scared of side effects. My body is so sensitive to many medications and I have done a lot of research on statins and am terrified!
Part of me is rationalizing that because my other lipids are normal, that it will "balance out" the crummy LDL. I'm probalby fooling myself, but I can't get past the fear of a bad reaction.
My diet isn't perfect, but I am making big efforts to eat healthier. I know the increased exercise will help too.
Neither doc thinks my high LDL can be lowered to an acceptable level with diet and exercise alone.
I want to do the right thing, but my fear is so great!
Is this my gut telling me to not take statins, or am I working myself up unnecessarily?
COMMUNITY LEADER
Sorry, don't want to start an argument, but your numbers are not correct or are not being quoted in their proper context. As some one with an advanced degree in statistical probability I can break these down for you if you would like. If you will give me the source of your Lipitor study I would like to review it, but I'm sure I have already read it.
Below are the correct numbers as reported by the NIH (not Pfizer);
"FINDINGS: Treatment was stopped after a median follow-up of 3.3 years. By that time, 100 primary events had occurred in the atorvastatin group compared with 154 events in the placebo group (hazard ratio 0.64 [95% CI 0.50-0.83], p=0.0005). This benefit emerged in the first year of follow-up."
This is from the ASCOTT trial that was done for Lipitor alone. These are the numbers accepted by the FDA. This represent an ARR of 46%, not the 1.3% you quoted. There may be a trial out there in which a control group with a relatively high risk was used, but ASCOTT used individuals on a consistent average risk and is considered the best trial fro Lipitor.
I'm sorry you have experienced sided effects, they do happen. The reported rate of side effects are 1 in 2,221 prescriptions for minor side effects (the same side effects were reported in 1 out of 2,223 in the placebo control group as well) and serious, life threatening side effects are reported in 1 out of 20 MILLION prescriptions which makes statins a very safe drug. Having said that side effects will happen.
Below are the correct numbers as reported by the NIH (not Pfizer);
"FINDINGS: Treatment was stopped after a median follow-up of 3.3 years. By that time, 100 primary events had occurred in the atorvastatin group compared with 154 events in the placebo group (hazard ratio 0.64 [95% CI 0.50-0.83], p=0.0005). This benefit emerged in the first year of follow-up."
This is from the ASCOTT trial that was done for Lipitor alone. These are the numbers accepted by the FDA. This represent an ARR of 46%, not the 1.3% you quoted. There may be a trial out there in which a control group with a relatively high risk was used, but ASCOTT used individuals on a consistent average risk and is considered the best trial fro Lipitor.
I'm sorry you have experienced sided effects, they do happen. The reported rate of side effects are 1 in 2,221 prescriptions for minor side effects (the same side effects were reported in 1 out of 2,223 in the placebo control group as well) and serious, life threatening side effects are reported in 1 out of 20 MILLION prescriptions which makes statins a very safe drug. Having said that side effects will happen.
I am not confusing anything. The numbers I quoted came from a Lipitor study, but if you want to talk about the Jupiter study, it is essentially the same thing - only the numbers are slightly different. They list the relative risk for total mortality as 12% between the Crestor group and the placebo group, 30% for a Coronary event and 19% for strokes.
The same numbers in absolute terms are 0.6%, 1.3% and 0.4% respectively. I am the customer here and if somebody tells me, you're increasing the risk for a Cardiac event by 30% by not taking Crestor, I probably would take it. But if you would say, there is only a 1.3% difference between taking the drug or not taking it as far as the risk for a heart attack is concerned, I would definitely not take it knowing (now) all the side effects these drugs have and having experienced them first hand.
The same numbers in absolute terms are 0.6%, 1.3% and 0.4% respectively. I am the customer here and if somebody tells me, you're increasing the risk for a Cardiac event by 30% by not taking Crestor, I probably would take it. But if you would say, there is only a 1.3% difference between taking the drug or not taking it as far as the risk for a heart attack is concerned, I would definitely not take it knowing (now) all the side effects these drugs have and having experienced them first hand.
COMMUNITY LEADER
This is all very easy to explain, no cover up here. First off, if you read the actual patient leaflet for say Lipitor, it says "Lipitor is shown to reduce the risk of heart attack and stroke", which is absolutely true. The reason that they have to use a disclaimer is because Lipitor alone will not prevent a heart attack. You can have uncontrolled high blood pressure, continue to smoke, have electrical issues with your heart or already have heart disease and no drug alone will prevent a heart attack or stroke under those conditions. It's no different than the way no birth control meds say they are NOT 100% effective in preventing pregnancy. This is another of those statements used by anti-statin groups to discourage patients from using statins which brings me to your second point.
You are confusing your terms, the numbers most commonly used are the RRR or relative risk reduction which gives a true representation of the reduction in the risk of cardiac events. The other number is ARR or absolute risk reduction which is representative of the actual end point results of a trial. The number you quote of 1% is again a number used by the anti statin crowd on all their literature which comes from the JUPITER trial and is WRONG. If you look at JUPITER, it was stopped early due to the great results to get Crestor on the market sooner. The problem is that by stopping it early, the ARR was understated as the trial did not reach it's endpoint. The projected number had the trial reached it's actual endpoint based on the results at the time it ended is conservatively placed as over 25%, but the anti-statin crowd point to the meaningless 1% number which has no significance as the trial ended early. In addition, every statin tested has a different ARR, up to 68% but the anti-statin group never mention that in any of their literature.
The following will explain more;
http://circoutcomes.ahajournals.org/content/2/3/279.full
You are confusing your terms, the numbers most commonly used are the RRR or relative risk reduction which gives a true representation of the reduction in the risk of cardiac events. The other number is ARR or absolute risk reduction which is representative of the actual end point results of a trial. The number you quote of 1% is again a number used by the anti statin crowd on all their literature which comes from the JUPITER trial and is WRONG. If you look at JUPITER, it was stopped early due to the great results to get Crestor on the market sooner. The problem is that by stopping it early, the ARR was understated as the trial did not reach it's endpoint. The projected number had the trial reached it's actual endpoint based on the results at the time it ended is conservatively placed as over 25%, but the anti-statin crowd point to the meaningless 1% number which has no significance as the trial ended early. In addition, every statin tested has a different ARR, up to 68% but the anti-statin group never mention that in any of their literature.
The following will explain more;
http://circoutcomes.ahajournals.org/content/2/3/279.full
If it is all so cut and dried with Statins, why do you still see disclaimers such as these by the drug companies:
Pfizer:
"Lipitor has not been shown to prevent heart disease or heart attack."
Astra-Zeneca:
"CRESTOR . . . has not been shown to prevent heart disease, heart attacks or strokes."?
What gets me most about this is the funny math they use. In one Lipitor study the outcome was 2 participants out of a hundred using Lipitor had a heart attack versus 3 in the control group. The claim was 36% fewer heart attacks. Apart from the math being wrong, they use relative statistics instead of absolute. In absolute statistics they would have had to say: "1% more heart attacks in people not using the drug versus the control group." Result would have been: big yawn.
Pfizer:
"Lipitor has not been shown to prevent heart disease or heart attack."
Astra-Zeneca:
"CRESTOR . . . has not been shown to prevent heart disease, heart attacks or strokes."?
What gets me most about this is the funny math they use. In one Lipitor study the outcome was 2 participants out of a hundred using Lipitor had a heart attack versus 3 in the control group. The claim was 36% fewer heart attacks. Apart from the math being wrong, they use relative statistics instead of absolute. In absolute statistics they would have had to say: "1% more heart attacks in people not using the drug versus the control group." Result would have been: big yawn.
"Over half the heart attacks happen to people with normal cholesterol"
What I struggle with is WHAT is normal? To just take a nationals average and take that as a 'normal' could be totally off the mark. Just because most people in the UK have 5.0-5.5mmol/L doesn't mean this is a normal level, for all we know 3.0mmol/L could be normal for the human body. A huge percentage of the UK population is eating rubbish foods, even those who believe they are eating healthy diets have no idea where the food has come from and understand half of what it contains. Out of interest, does anyone know what the average cholesterol is for newborn babies?
What I struggle with is WHAT is normal? To just take a nationals average and take that as a 'normal' could be totally off the mark. Just because most people in the UK have 5.0-5.5mmol/L doesn't mean this is a normal level, for all we know 3.0mmol/L could be normal for the human body. A huge percentage of the UK population is eating rubbish foods, even those who believe they are eating healthy diets have no idea where the food has come from and understand half of what it contains. Out of interest, does anyone know what the average cholesterol is for newborn babies?
COMMUNITY LEADER
The statement;
"Over half the heart attacks happen to people with normal cholesterol"
Is one of the most over used and misleading statements used by the anti-statin groups to discourage patients from taking life saving statins. There are many flaws with this statement. First, by only looking at the people who have heart attacks as your control group does not account for the millions and millions of people that have normal cholesterol levels and never have a heart attack. The 50% as a result grossly overstated when looking at the relative risk of having a heart attack with normal cholesterol levels compared to high cholesterol levels. Also, there are many mechanisms for a heart attack, not just those caused by excessive plaques. Some heart attacks are due to electrical problems that effect the hearts ability to contract, some are cause by vasospasms and some are caused by small vulnerable plaques that become damaged a clot. Cholesterol has no affect of these mechanisms so to say that half of all heart attacks happen to individuals with normal cholesterol numbers is meaningless. It's like saying that half the people that have car accidents have normal vision, total nonsense.
Yes, LDL is a major building block for cells and is necessary for the function of some organs such as the brain and even for muscle movement. But how much is enough and how much is too much? At what point does LDL become excessive and cause plaques to form? Why have there been NO studies to prove that cholesterol is not a risk factor for heart disease? The money is available, anyone or any group can go to the NIH and apply for funds to run a trial, but no one ever does. Why is that? What is the "best research" you are referring to? I have found nothing but speculation and conjecture on the subject. What I can find are many studies proving a link between cholesterol levels and heart disease, and not all are funded by drug companies.
It sounds like the OP's doctor is going by the best research available when weighing the benefit to risk and recommending a statin.
Jon
"Over half the heart attacks happen to people with normal cholesterol"
Is one of the most over used and misleading statements used by the anti-statin groups to discourage patients from taking life saving statins. There are many flaws with this statement. First, by only looking at the people who have heart attacks as your control group does not account for the millions and millions of people that have normal cholesterol levels and never have a heart attack. The 50% as a result grossly overstated when looking at the relative risk of having a heart attack with normal cholesterol levels compared to high cholesterol levels. Also, there are many mechanisms for a heart attack, not just those caused by excessive plaques. Some heart attacks are due to electrical problems that effect the hearts ability to contract, some are cause by vasospasms and some are caused by small vulnerable plaques that become damaged a clot. Cholesterol has no affect of these mechanisms so to say that half of all heart attacks happen to individuals with normal cholesterol numbers is meaningless. It's like saying that half the people that have car accidents have normal vision, total nonsense.
Yes, LDL is a major building block for cells and is necessary for the function of some organs such as the brain and even for muscle movement. But how much is enough and how much is too much? At what point does LDL become excessive and cause plaques to form? Why have there been NO studies to prove that cholesterol is not a risk factor for heart disease? The money is available, anyone or any group can go to the NIH and apply for funds to run a trial, but no one ever does. Why is that? What is the "best research" you are referring to? I have found nothing but speculation and conjecture on the subject. What I can find are many studies proving a link between cholesterol levels and heart disease, and not all are funded by drug companies.
It sounds like the OP's doctor is going by the best research available when weighing the benefit to risk and recommending a statin.
Jon
It is very clear from the best research that ldl or total cholesterol levels have absolutely Noghing to do with anything. Your doctors need to read responsible research and quit listening to the drug reps and heeding the bad research on statins which is funded by the drug companies. Over half the heart attacks happen to people with normal cholesterol, ldl cholesterol is necessary for human health and not "bad"at all, old folkx wit
Don't agonize, take the statin. You could sit there until you suffer a heart attack "wondering" if the statin could potentially cause a side effect, or you could take it and know for sure - and it probably won't do anything except lower your cholesterol.
My father has now been on Crestor for a couple of years. His cholesterol was over 300. His most recent numbers on Crestor are amazing - total cholesterol is 124, and I regret to say he still eats badly, so imagine the benefits! Crestor actually eats the cholesterol already accumulating. It's good stuff.
I'd take it. I wouldn't even blink.
My father has now been on Crestor for a couple of years. His cholesterol was over 300. His most recent numbers on Crestor are amazing - total cholesterol is 124, and I regret to say he still eats badly, so imagine the benefits! Crestor actually eats the cholesterol already accumulating. It's good stuff.
I'd take it. I wouldn't even blink.
I have been on Lipitor (40 mg) and Zetia (10 mg) for 3 years - no side effects that I can notice. You should have your liver enzymes checked every 6 months. I have not had any problems and it dropped my LDL from 330 to 97. With an LDL over 200, you should definitely take the statin. The side effect of high LDL is much worse.
I, like you, worried about taking statins. My LDL level was about the same as yours. I lost weight, worked out regularly, adopted my wife's vegetarian diet, and dropped the LDL level almost 30%. I was still patting myself on the back when I had the first of three heart attacks and numerous stents installed! I consistently read that a 30% drop in cholesterol can be achieved with diet and exercise. If that happened in your case, your reading would be about 200 -- still too high for good heart health.
Believe me, the terror of a heart attack trumps the fear of taking Statins! If you start taking Statins, simply have your blood tested periodically. The blood tests will tell you if there is a problem. I sure wish I had followed my doctor's advice to take Statins before my heart was damaged. I take Vytorin now, and my LDL is under 100, my HDL is about 60.
Believe me, the terror of a heart attack trumps the fear of taking Statins! If you start taking Statins, simply have your blood tested periodically. The blood tests will tell you if there is a problem. I sure wish I had followed my doctor's advice to take Statins before my heart was damaged. I take Vytorin now, and my LDL is under 100, my HDL is about 60.
I would take the statin. The docs will do bloodwork to make sure you are ok. The benefits outweight the risks.
I've been on Lipitor since 18 or so, and switched to Crestor at 28--been on Crestor & Zetia for 2 years and have not had any ill side effects.
Crestor does a great job at lowering overall and LDL, IMO.
I've been on Lipitor since 18 or so, and switched to Crestor at 28--been on Crestor & Zetia for 2 years and have not had any ill side effects.
Crestor does a great job at lowering overall and LDL, IMO.
Thank you to all who replied! I really appreciate it!
Just one additional question though......my PCP says that the "older school" statins tend to have fewer side effects than the newer drugs and that is why he prescribed the lovastatin. Do you agree? Also, do you think "brand" Rx is superior to "generic" Rx?
Thanks again for your support!
Just one additional question though......my PCP says that the "older school" statins tend to have fewer side effects than the newer drugs and that is why he prescribed the lovastatin. Do you agree? Also, do you think "brand" Rx is superior to "generic" Rx?
Thanks again for your support!
Hi There,
I kind of agree with what the others have said...it'd be pretty stinking hard to drop that # with just diet and exercise. Have you ever had that cholesterol particle study done? It's a cholesterol screening that looks at the size of your LDL; large LDL particles are bouyant and small LDL particles could potentially stick to the walls. That would give a more specific look into your cholesterol profile I'd guess.
I too have read all the horror stories about statins but I've also heard from lots of people on this forum who have had great success with them! It sounds like a difficult decision to make and I wish you good luck. Best wishes (:
momto3girls
I kind of agree with what the others have said...it'd be pretty stinking hard to drop that # with just diet and exercise. Have you ever had that cholesterol particle study done? It's a cholesterol screening that looks at the size of your LDL; large LDL particles are bouyant and small LDL particles could potentially stick to the walls. That would give a more specific look into your cholesterol profile I'd guess.
I too have read all the horror stories about statins but I've also heard from lots of people on this forum who have had great success with them! It sounds like a difficult decision to make and I wish you good luck. Best wishes (:
momto3girls
I was like you scared to death to take statins. My LDL was 231, the rest HDL and Trigs were perfect. I tried for one year to get the LDL down. I already exercise every day and eat healthy, I tried all the natural stuff to lower my LDL including the stuff you can buy without a prescription at the Health Food Stores. I spent a lot of money on that stuff which did not help me. In one year my LDL went from 231 to 220. Doctor had a fit. Told me I was a walking time bomb, if I wanted to die of a heart attack or stroke and if this was o.k. with my family then I do not have to go on statins. That scared me so much that I let him prescribe Zocor 20mg. I was suppose to take one every day, but took one "every other day" but did not tell him. My LDL went from 220 to 130 in only two months, and I got the doc off my back. Total cholesterol went from 306 to 180. This was 3 yrs ago and I have absolutely NO side effects from the Zocor.
You will read about people who had success with stuff from the Health Food Stores, and diet, but I have yet to read a case where the person had a high LDL as I had or a total cholesterol number over 300 who got help with natural stuff. So much that their cholesterol and the LDL went into the normal range.
You will read about people who had success with stuff from the Health Food Stores, and diet, but I have yet to read a case where the person had a high LDL as I had or a total cholesterol number over 300 who got help with natural stuff. So much that their cholesterol and the LDL went into the normal range.
An LDL of 204 is high. I'd take the statin. You may have a familial propensity to high LDL. A healthy diet and regular exercise will help, but from 204 to a safe range? Only if you are like my friend's husband and doing ridiculous things like eating a half gallon of full fat ice cream almost daily.
There is a website called Fit Day. It's free and it will track what's in what you eat as long as you enter everything you eat.
There is a website called Fit Day. It's free and it will track what's in what you eat as long as you enter everything you eat.
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