Lipid Criteria For Statin Medication

[jerry1978]

I am a 44 year old male, non-smoker, currently on the following meds: Toprol XL 25 mgs and Hydrochlorothiazide 25 mgs for anxiety-produced hypertension; along with Klonopin 0.25 mgs and Zoloft 25 mgs for Anxiety and Panic Disorder.

I have been on these meds for 1 year with good results.  I have always had good lipid readings, however, since beginning these meds, it appears that my lipids have risen.

My recent test are:
TC-220
HDL-56
LDL(calculated)-113
TRIG-253
CHOL/HDL ratio-3.9

My questions are:

(1) Am I a candidate for Statin therapy?

(2) Can the LDL be accurate, being that it was calculated with a TG level of 253?

(3) Can the current meds I am on raise lipids?

(4) As an aside, concerning APO B/A1 ratio, seven years ago I had mine measured and it was 0.82, with A1 being 146, and B being 120....Are these safe numbers?

Thanks, Jerry

[CCF-M.D.-MJM]

Hi Jerry,

A couple things.  You HDL is good at 53.
I see you have one classic cardiac risk factor : hypertension

You are not a smoker
I assume you are not a diabetic
You didn't mention a family history of a first degree relative (father, mother, sibling) with an MI before the age of 55 in men and 65 in women.
I am certain that menopause is not a concern either.....

Based only one cardiac risk factor, your LDL is appropriate at 113.  Your triglycerides are a bit elevated at 253, however, I bet with some diet and exercise they would fall down.

Try increasing your exercise under your doctors supervision,
modify your diet to low in saturated fats, low in simple (not complex carbohydrates or fiber--they are a must) and I bet your lipid panel will look better next time around.

The recommended daily fiber consumption is 28 grams.  I challenge you and other posters and readers to look at their daily fiber intake and see how close you are to 28 greams.  I think the average American is about 8-10 grams.

direct answers to questions:
1. Not right now for the reasons mentioned above
2. It is accurate enough for your risk factor profile.  I would not be too worked up about your levels, they are actually pretty good and could be better with little work.

3. both atenolol (beta blockers) and hydrochlorathiazide can adversely effect lipids.  They have a STRONG proven benefit and would not consider changing your regiment.

4. I actually do not know much about cholesterol subtypes and do not know the answer to this question.

Good luck!

[knicks30]

Doctor what foods do we have to eat to reach 28 grams of Fiber? Or can we take supplements?

Thank you.

[Marilyn (runner)]

Hi,  I'm not a doctor - but I have to really endorse the doc's comment about the 'fiber' daily intake.  It seems not much attention is mentioned on the daily fiber intake.  I didn't know what the recommended amount was per day - until I read the doctors post.   I started eating "Fiber One' cereal with 'skim' milk along with a fruit in my cereal for breakfast.  It actually tastes really good.  For lunch I always have "Arnold's Whole Wheat Bread"  which has 3gm of fiber in 'each' slice and I have a no fat bologna or 2gm fat ham and a no fat slice of cheese with 'mustard' which is no fat.  No FAT potato chips and then a fruit for lunch.  Then for dinner - since I don't consume much salad because of my 'coumadin' - I try to have a small/medium portion of meat and some starch but I usually include a vegatable which takes up 1/3 to 1/2 of my plate portion.  But, I can't resist a 'dessert' after dinner.  :-)  I have a terrible sweet tooth.  

But, good nutrition is SO important... actually I think its extremely important when battling heart disease..  
Best Wishes
Marilyn (runner)

[Dr. Erik]

YOU ARE A CANDIDATE FOR STATIN THERAPY UNDER NEW GUIDLINES. ZOCOR DECREASES YOUR RISK OF A CORONARY EVENT REGARDLESS OF CHOLESTEROL LEVELS. I WOULD ASK TO BE PUT ON IT. THIS IS MY OPINION. THE DOCTOR IS CORRECT GOING BY THE OLD GUIDLINES.

[jerry1978]

According to the ACTP guidelines, I believe you are incorrect, Erik.
From their guidelines, therapy would consist first in bringing the LDL to the desired level.  Regarding my case, with only 1 risk factor, that level should be <130.  I am well within that goal with an LDL of 113.
Further, with LDL within goal, and Triglycerides above 200, the next goal is for  Non-HDL levels to be <160 for someone with 1 risk factor. (Non-HDL is TC-HDL.)
My Non-HDL is 164, so I am only 4 points away from the goal, so therefore, I do believe that the doctor is correct.
Thank You, however, fot sharing your comment with me.
Jerry

[Dr. Erik]

I tend to think the current guidelines are not aggressive enough and there are a lot of cardiologists who feel the same. I'm sure you will be fine not taking a Statin but it wouldn't hurt to take one and it would only lower your risk even more. My thinking is be aggressive to prevent trouble before it starts.

[jerry1978]

You and I think alike.  If you read any of my previous posts, you can see that I also like to think and act "preventive".  In fact, one of my favorite authors on preventive heart disease is Dr. Ken Cooper of the Cooper Aerobic Clinic....this man was and is years ahead of his time.
My semi-annual checkup is next week, and I will be suggesting to my Doc that I wish to go on a statin.
I just posted the guidelines as I thought you may not have seen them.
Thanks, Erik.

[Dr. Erik]

Jerry-

That is exactly what I did. I asked my doctor to put me on a Statin. If he didn't I would have found a doctor who would. People like yourself and I will hopefully stay one step ahead of Heart Disease. Best of luck to you!

See you on the forum.


Erik