Cholesterol and TriCor

[agray100]

My question is regarding cholesterol, triglycerides and TriCor.

I recently saw a cardiologist for a stress test as part of a routine physical.  Passed with no problem, but initial BP was a bit high (125/90), although normal by the end of the test.  However, cholesterol levels were high (about 240) with the good cholesterol only about 30.  Triglycerides in the low 200s.  I am 48,  5' 11", 165 - 170 pounds, and there is no history of heart disease on either side of my family; however, my cardio wanted to get those numbers in line.  He suggested niacin extended tabs, but I cannot swallow pills.  No other medical conditions other than allergies.

He suggested I try TriCor (160mg).  Since they are not an extended type of drug, the manufacturer did not see where crushing them would be a problem.   However, internet research indicated TriCor can cause muscle pains, and other side effects. He also suggested the new CAT scan to see if there is any build-up in my heart arteries.  Thankfully, there is none.

I prefer other methods  (i.e., diet and exercise) of controlling my numbers other than drugs.  I eat no dairy, (lactose problem) and I will force myself to begin eating fish to get the benefit of the fish oil. How do you feel about TriCor?  Are there success stories out there?  Are there downsides?  Are there long term problems with this drug?  Are there better alternatives?  Do they affect PVCs in any way?  And somewhat related--I found niacin tablets at our local drugstore at 100mg strength that melts in your mouth.  Would they work if spaced out?

Thanks!

[Cleveland Clinic]

agray,

when to initiate and what regimen to initiate is always a difficult question.

The only tru guidelines are based on LDL cholesterol, but as we develop better methods of treating HDL cholesterol and Triglycerides, the treatment options will become more complex.

Assuming a Triglyceride level of about 200 I calculated your LDL to be about 170 using the Friedewald equation.  Based on the information you provided, you have no other cardiac risk factors and it would not be unreasonable to try lifestyle modification therapy for attempts to lower your LDL cholesterol. These may also have some impact on your HDL and triglyceride levels as well.

There is not alot of data on tricor or other LDL and TG treatments. I personally feel the best drugs and most well studied drugs we have for prevention at this time are the statins and would consider them if your LDL remains in that range after therapeutic lifestyle modifications.

The side effects and downsides of tricor are about equivalent to the statins and include muscle aches.  These medications have never been shown to effect PVCS.  

Niacin from the drug store has more side effects of flushing. This abates after awhile.  It would be the same as the long acting form

hope this is a start.

[raildown]

I would certainly start with diet and exercise for 3-6 months to see what you can achieve; your CAD risk profile looks quite low;

what 'targets' does your doctor have for your various chol measures ?

several years ago the results of my physical showed elevated TG (314, previous 250) and low HDL (25,previous mid-30s) and I had slipped on my exercise ( I had been an avid jogger for decades at about 30-40 miles per week as well as other sports activity);

internist suggested Tricor 160 mg...as always I resisted meds but after discussion of my family CAD history I reluctantly acquiesed to diet (modified low fat - veggie diet - Mediterranean with some fish and chicken) , exercise (walk/jog 1 hour per day) and Tricor 160 mg ( I had asked for the lower 57 mg but he said no); I had suspicion that high TG was related to drinking (too much) grape juice ( I thought it was better than Coca-cola ...wrong ! ;

within 10 weeks my TG went from 314 to 49 ! and HDL from 30 to 45;

at 3 weeks, I had some nasty constipation which was solved with bran/prunes/applesauce mixture, but then after 8-10 weeks I started having a pins and needles feeling in my calves as well as numbness in both toes ...peripheral neuropathy ?...was sent for MRI for possible MS dx...other neurological tests...all negative;

I had stopped Tricor on my own...and the neurologic symtoms Very slowly receded...;

after this with lipid testing, I discovered as well that the diet and exercise had been Very effective with lowering TG (now at 105) and raising HDL (now at 41) ;

note all drugs have side-effects...some quite modest and some florid or worse; the key is whether a side effect is likely to be reversible; niacin in cholesterol lowering doses is a drug which has side-effects such as flushing, itching, and impacts on the liver etc...don't trea it like candy;

      initial   diet/exer/Tricor   diet/exercise  

TC     197          126              179
LDL    109          71                91
HDL     25          45                41  
TG     314          49                105  

from conversations with others, I have discovered that diet (lose the Refined carbs, sugars, flours, fruit JUICES...go whole wheat, whole fruits, whole veggies Unprocessed whole foods) and add vigorous exercise and TGs PLUMMET...HDL is harder to move but again diet helps some, and Intense exercise is key...;

Tricor and other chol lowering meds have been shown to have benficial effects besides the lipid lowering, to wit these meds have endothelial (liing of vessels) function benefits that may in fact be the key to their benefit;

I have since found isolated Rare reports by individuals on various internet forums and in the medical literature on PubMed about PN (peripheral Neuropathy) from Tricor (and statins)...YMMV;

summary: diet and exercise first, then start with lowest dose possible and titrate (change) very slowly;

be well my friend;

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