Cholestrol drugs

[copyman]

is anyone taking a statin and/or niaspan for their cholestrol while on tx, before tx or after tx? i am curious as my primary wrote me prescriptions for both meds and told me to tell my hep doc i will be taking them. when i asked him about the damage these drugs can do to liver he said if i do nothing with my very bad HDL & LDL that most likely a stroke or heart attack will eventually get me! i see my hep doc on 12/20 and will run it past him but wanted your opinion on this. i really hate to start these because i heard once you start you have to take them the rest of your life. and besides i think once i start tx and my liver starts to get a break the lipids will start to normalize, not sure but just a feeling i got. thanks

[jmjm530]

Given the state of your liver and current drugs, you may have to simply lower LDL at some point (probably after treatment) and live with a low HDL*. That is my plan.

Of course, there are non-drug strategies for raising HDL such as exercise, possible dietary intervention such as certain "good" oils  and (CONTROVERSIAL STATEMENT COMING :)* moderate consumption of red wine. The latter is something to discuss with your hepatologist after SVR, etc, etc, etc. Unfortunatly, my low HDL is genetic and pretty much resistant both to exercise, diet and alcohol.

All the best,

-- Jim

* Early research by Nathan Pritkin (not a bonafide doctor but a bonafide genius) suggest that a low HDL is OK as long as TC is below 140 or thereabouts. This was based on studies of New Guinea natives who have very low HDLs but also low TC as they eat primarily different varieties of Sweet Potatoes. They have no cardivascular disease despite low HDL. If you are disciplined and very concerned about cholesterol, etc, you might want to check out the Pritkin diet. I do not advise it at all, however, during treatment for any number of reasons, but maybe afterwards.
http://www.pritikin.com/

All the best,

-- Jim

[copyman]

it is my primary doc that is so concerned, i have yet to discuss this with the hep doc. will see hep doc 12/20 and get his opinion. like i posted before my total choles & tris are in normal range, it is my HDL 19 & LDL 143 with small particle size that is concern. thanks again

[jmjm530]

Re-read your post. Didn't know they had studies using statins *during* treatment. Are you sure? Can you post them? Thanks.

-- Jim

[jmjm530]

Again, I was told not to take statins on treatment but this was before the studies came regarding statins and the HCV virus. This would be a good question for a hepatologist well versed in latest goings on. My guess is that they might say not enough is known on statins alone -- yet the combination of statins and the tx drugs -- to take a chance. Again, just my guess. Again, keep in mind that my Total cholesterol dropped from over 200 to as low as 140 on treatment because of the treatment drugs. Don't know how common this is but I'm sure I'm not the only one this happened to. I'm a bit puzzled why your doctor is so focused on your lipid profile when I would imagine the focus should be on your treatment, and then take care of your lipids after treatment. At least this was the attitude of hepatologist. Even my cardiologist didn't mind that I waited 6-12 months after treatment to start statins.

All the best,

-- Jim

[crsrph]

so I take it you do not like the idea of replacing ribavirin with lescol for tx

[copyman]

hi jim, what are your thoughts about the studies using a statin with tx? i could not find it to post a link but i remember reading something about success with it? figured i could "kill 2 birds with one stone" (cholesterol & hcv) if my doc said it was ok to take it. thanks again for the good advice

[jmjm530]

Definitely run Niaspan by a hepatologist (or two) before taking it. From what I was told, no statins or Niaspan during treatment and not sure my doctors would even allow me to take Niaspan now that I'm SVR, even though my HDL is around 30.

Not positive, but pretty sure Niaspan is more liver toxic than statins. Anyway, maybe you will get lucky and have your lipid profile temporarily get better when/if you treat -- that is what happened with me.  

I would think your focus right now should be on treatment, not your cholesterol, assuming you are getting ready to treat. Of course run everything by a good hepatologist and cardiologist first, and consider getting an exercise stress test prior to treatment, as was recommended to me and some other here.

All the best,

-- Jim

[copyman]

hi thanks for your reply. i know we have discussed the cholesterol issue before. i had a few questions for you, if you were me would you take at least the niaspan to raise the HDL? and what is your take on this labcorp test NMR lipid profile, it goes into depth about particle sizes. my particle #'s are way out of range. my nephew is a pharm rep for niaspan and avacor and he explained that having small particles like i do is very bad. do you know anything about this? he said this test and the even better berkeley test go into great detail about the lipids and particle sizes and this can tell much more about risk factors for CVD.

[jmjm530]

I was told not to take statins until treatment was over. As to niaspan, probably even more problamatic -- not even sure if they will let me take it post treatment -- but even if they do, niaspan often causes a flushing response, and given my rosacea issues, it will probably be contraindicated for that alone.

FWIW my lipid profile was remarkably good all during treatment both in terms of total cholesterol, LDL and triglicerides. However, three weeks post tx it returned to where it was pre-tx and even worse. I'll probably start statins pretty soon for this reason. Why interfereon lowers LDL for some like myself, and doesn't for others I really don't know. The other thing to keep in mind is that LDL and the virus share the same receptors so ironically having a lousy lipid profile pre-tx (high ldl) actually increases your chances of SVR.

All the best,

-- Jim

[jboyhk]

Can you pls provide sound proof for this statement "do have A high risk of side effects".

The side effect you are talking about is in the low risk category not high risk.

[West Village gal]

CM, my partner had started on niaspan for a brief time, maybe a month and a half, before beginning tx because of low HDL and the relation, point by point, in increase in HDL and decreased risk of heart disease.  As soon as tx started, though, he was taken off the niaspan, the thinking being that it was not worth the risk of increased stress on the liver during tx.  His triglycerides have doubled since tx, but again, the recommendation was to deal with that via exercise and diet until tx was concluded.  For what its worth.

[copyman]

total cholestrol 188 (WNL), tris 130 (WNL), LDL 143 (HIGH), HDL 19 (LOW). but what has me & primary doc concerned is the particle size of the cholestrol. this in depth test they did shows more then the normal #'s, something about the size of particles and amount of particles can be a factor to treat with the cholestrol drugs.

[MissMiss]

I don't know a lot about this but will share what I do know.

When I finished tx about 4 mo ago, I had myopathy in my legs real bad.  The Neurologist that did the test kept asking me if I was or ever had taken these type of drugs.  I guess he had one fella who had leg myopathy real bad and it was directly related to the statins.  Not to scare you because this is uncommon if I understand correctly.  My myopathy was either from the Peg, rescue drugs or actually using my legs for injections.

Also, my husband's cholestoral was the highest our PCP has ever seen.  I forget what he is taking (and only one tab a day not the two rx'd) helped lower his numbers dramatically.  He is still quite high but with exercise and diet it is lower at each poke of the needle.

Your HCV doctor should be able to guide you.  Good luck.  BTW, what are your numbers?  Triglycerides too?

miss

[NYCMark]

My hep doc put me on Tricor to help manage my lipids and cholesterol while on treatment. Risks of stroke and heart attack are real, especially with other factors such as older age, elevated blood pressure, etc.  Of course, diet modification and aerobic exercise are also suggested, but you know how that goes.....

Mark

[ladybug52]

Do you have high blood pressure,are you overweight, smoke or have a family history of heart disease? There's more than one factor to consider when determining stroke or heart attack risk. Just ask the Dr. on the 20th. It's only 6 days away. Plus, there are these 2 things known as exercise and diet (I hate both words) that can help lower cholesterol too.
Are you still starting tx in January? I hope all goes well if you do. I am so relieved to have started last Fri. The waiting and worrying was the worst part.
Bug

[jboyhk]

Also the studies I have read show that HepC actually lowers your cholesterol slightly. So it will be higher when you get rid of it.

[jboyhk]

I don't understand your concern about taking them for the rest of your life. Its not like you become dependant or hooked on them.

If you don't take them, the rest of your life could be shorter than if you did take them.