Colestipol cost:benefit assessment

My cardiologist has prescribed an increasing dosing regimen of colestipol granules to help lower my LDL level.  Here are my last two most current labs from before I started the colestipol.  I eat a lower fat diet, exercise by walking 40 minutes 5-6 times per week, don't smoke, control borderline hypertension with 5mg lisinopril daily, have a BMI of 30 but don't have enough self control to lose any weight.  I had muscle pain and memory loss with statins, flushing and finally facial swelling with niacin supplements.  The memory loss was so bad, I sold my veterinary practice and retired BEFORE the lawsuit.  I ran for exercise until I wore out my left knee, now I walk.

Again, these labs are before any medication.

4/29/09 9/10/09

174 157 Total LDL Ch Direct
29 36 Total HDL Ch Direct (HDL2+HDL3 *good Ch)
248 241 Sum Total Cholesterol (Total amt circulating)
258 239 Triglycerides Direct (Increased assoc with CVD)
B Real LDL Size Pattern (A-Ideal,A/B-moderate, B-High)
Sub-Class Information
4 HDL-2 (most protective)
25 HDL-3 (least protective)

I'm now on 10mg colestipol granules twice daily in the 500gm bottle of powder and 54mg fenofibrate once daily.  I have two questions.  I've read that colestipol may lower LDL 20% at 15gm twice daily.  I'll have my blood rechecked after I've been on 30gm/d for about a 6 weeks.  

Is the cost (about $300/month) worth the benefit of hopefully lowering my LDL 20%?  I've asked my cardiologist that question twice and not received an answer.  It is a lot of money and our health insurance doesn't cover prescriptions.  Second, I've tried mixing it with oatmeal, yogurt, milk, soup, tea, you name it.  It's like eating sand!  Since it's mostly silicate which IS sand, that isn't much of a surprize, but I don't like it.  The pills were easier but cost about $1,125/month.  Can you help me?

[joanincarolina]

I can't comment on the cost vs benefit of a better lipid profile but to me I'd go with the lowering of lipids to prevent future problems. Did you try the Niacin with aspirin to reduce side effects taken at bedtime? Niacin can do wonders on the LDL especially when there may be a corkscrew like protein attached to it and no amount of statin, diet or lifestyle change will impact the LDL  but Niacin will. It is referred to as LPa and can be done in some advanced lipid testing. That alone may change and further define what you need to be on. Also, did you take the statin at night and to reduce the side effects of it, take a smaller daily dose of CQ10 with it at night? There are some pharmaceutical companies that have programs for cost reduced drugs that a doctor orders if you are eligible for it; I recall it is income based and is in the US. Hope this helps. Joan.    

[LesR]

Thanks for taking the time to answer Joan!

Did you try the Niacin with aspirin to reduce side effects taken at bedtime?  
Yes, I was up to a gram or two/day but the one incident of severe facial, body, and throat swelling (allergic reaction) precluded me from continuing any niacin according to my family practitioner at the time.  It also only raised my HDL 3 or 4 points.

Also, did you take the statin at night and to reduce the side effects of it, take a smaller daily dose of CQ10 with it at night?
I didn't take the statin at night, that was never suggested.  I did try all the common statins in increasing introductory dosages from 5-20mg like lescol, pravachol, lipitor, crestor, red yeast rice, high dose EFA nutraceutical and one other I can't remember over a 10 year period.  The memory loss is not responsive to CoQ10 and that was the most serious side affect.  I'm told now, that I should never take more statins because very little is apparently known about the rare side affect and much more severe reactions are possible.

There was an article in the Wall Street Journal a couple months ago that stated in the cost:benefit ratio that "using a statin costs about $150,000 for every year of life it saves in men, and even more iin women."  There is no mention of other drugs, but the ratio is most likely lower than statins or we'd hear more about them.  It is very suspicious that we don't hear about what % benefit statins provide, especially when we hear how substituting oatmeal for breakfast will lover cholesterol 1-2% which is generally statistically insignificant.

I'm still looking for a reputable source that can tell me how much lowering LDL 20% will decrease my or anyone's chance of having a heart attack?