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Enoch Choi, MD  
Male, 39
Palo Alto, CA

Specialties: Family Medicine

Interests: sinusitis, Migraine, Low back pain
Palo Alto Medical Foundation
Urgent Care
Palo Alto, CA
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Have a high CRP? Crestor may significantly lower heart attacks, strokes and need for surgery for blocked arteries

Nov 10, 2008 - 19 comments
Tags:

statin

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CRP

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c reactive protein

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Heart Attack

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Stroke

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angioplasty

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Heart bypass



For low risk individuals with a high CRP taking crestor (rosuvastatin calcium), "we reduced the risk of a heart attack by 54 percent, the risk of a stroke by 48 percent and the chance of needing bypass surgery or angioplasty by 46 percent" reported Paul Ridker of Harvard-affiliated Brigham and Women's Hospital in Boston, who led a new study released yesterday at the annual American Academy of Cardiology meeting. It involved 17,802 people with high CRP and low LDL cholesterol (below 130) in the U.S. and 25 other countries.

One-fourth were black or Hispanic, and 40 percent were women. Men were 50 or older; women, 60 or older. There was no past medical history of heart problems or diabetes.

They were randomly assigned to take a placebo (dummy pills) or Crestor, made by British-based AstraZeneca PLC.

The results were significant enough that the trial was halted early, only after 2 years because the evidence was strong enough to consider placing all participants on crestor.

If insurance companies decide to cover the expense, and it is adopted by those who qualify, it could cost many billions of dollars to cover the expense but possibly avert 30,000 heart attacks.

Before you run out to ask your physician for the CRP test, consider if you're willing to foot the cost of crestor or other statins yourself because at this time you'll be paying $1-$4 a pill, every day.  A cost that's pretty difficult to swallow in these economic times.

Crestor: http://www.medhelp.org/drugs/Crestor/show/3468

Lipitor: http://www.medhelp.org/drugs/Lipitor/show/3078

Thousands of articles on the research:
http://news.google.com/news?client=safari&rls=en-us&ie=UTF-8&oe=UTF-8&hl=en&resnum=1&ncl=1268542933


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by Sandy M, Nov 10, 2008
Dear Dr. Choi,

It's good to know that MedHelp is right up on the latest information!  Our family watched a report on "statins" last night on our local news.  Are there dangerous side-effects to these drugs that need to be considered before beginning statin treatment?

Sandy

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by Enoch Choi, MDBlank, Nov 10, 2008
There are potentially serious side effects, including possible liver and muscle damage.  That's why liver function and muscle tests (LFTs and CK and CPK) are monitored regularly, more frequently at the start of treatment.

In the initial research for Crestor, Chinese subjects in Singapore were noted to metabolize Crestor less rapidly, leading to recommendations to not take more than half the maximum dose recommended for other ethnicities, to ward off potential side effects.

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by whatever4, Nov 11, 2008
Yup and Crestor also can do all kinds of harm, as it did with me I could not even take a step out of my bed. I had hardly any muscle tone anymore. It was like my muscles had disappeared. Also very low cholesterol is associated with severe depression your brain needs cholesterol.

Sorry, this study is done by the same people who manufacturer the drug!!! More people die from pharmaceutical drugs then people on street drugs.


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by Enoch Choi, MDBlank, Nov 11, 2008
Whatever4, I'm so sorry about your suffering.  Statins are not commonly known to cause muscle wasting.

I'm not aware of an association between very low cholesterol and depression.  Early studies 2 decades ago linked very low cholesterol to increased mortality but after controlling for those with advanced terminal illness with low cholesterol, this association was disproven

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by Ray62, Nov 11, 2008
Dr. Choi,
These data are clear.I read the recent research with great interest.It is not clear if you are speaking to statins in general,or Crestor in specificity.Data on Lipator ( a statin) over a16 year period has produced impressive results.
Indeed, there is some word that a lower dose version maybe offered over the counter. Your opinion on this?
RS

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by Enoch Choi, MDBlank, Nov 11, 2008
Ray62,

My initial writing above is about Crestor since that was what the research was based on.  The interesting thing to see going forward is whether or not this effect is borne out in larger trials and in other statins.

As you look forward to statins going over the counter, I think of what my Cardiology professor told us repeatedly in residency: "It should be in the water".

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by RHONDAARTMAN, Nov 11, 2008
I have had a bad reaction when I took Lipator. Can I take Crestor or is it almost the same drug. I have kept my cholesterol down on my own with diet and walking 4 miles a day. However this summer we opened a resturant and needless to say it went up again(all the fried food). I have been back to watching what I eat but am not sure I want to start on meds again just yet? Any insight on the 2 drugs and if I can take Crestor after a bad reaction to Lipator. The reaction was sever chest pains after a week and very week muscles in my legs. Thanks for your input.

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by Enoch Choi, MDBlank, Nov 11, 2008
Rhonda Artman,  Crestor and Lipitor are different drugs.

My favorite food is fried food, where's your restaurant?  Yes, i'm on a statin.

You need to ask your doctor if Crestor is appropriate for you.

Unfortunately, the risk of muscle injury is shared across the entire statin class.

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by RHONDAARTMAN, Nov 11, 2008
So do you think I should talk to her about starting Crestor or should I keep trying to bring down my cholesterol on my own again? By the way the place is in a town call Lena,ILL if you are ever out this way I will make you some "Killer" fried chicken with all the works( I love to cook) My only worry is if I start taking meds again that the same reaction will happen. It took only 6 days to react to the meds and it was a scary feeling. My total have been 186 now up to 225 ouch like I said it went high after opening the rest.

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by Me967, Nov 14, 2008
Hi Dr. Choe.  

Just a little history on myself first.  I've taken Lipitor for over a year for my cholesterol but mainly I think for my hs CRP levels.  My total chol. is 211, HDL 63, LDL 127 and Tri. 127 now and my hsCRP is down (on a 1-3 scale) to 6 from 20.  So it has helped me there.  
I also take Levothyroxine for Hypothyroidism ~6 months.  My numbers for that is TSH .98 (.34-5.6), Free T4 is .66 (.58-1.6) and my T4 is 6.9 (6.1-12.2).  
My BP and HR I take Lopressor for hypertension and Diazide/Maxide for edema for the last 5 years.  Also low dose aspirin for an interatrial septal aneurysm.  EF is 50-55.   Liver test by the way are normal.  

My question is the massive spasms, back, chest and all over body pains.  Weird but mainly in the colder months.  

It states on both that you should use "caution" taking these concerning if you have Thyroid issues. ?  
What is the caution concerning thyroid issues and Statins?  
And would the caution over ride the cholesterol and hsCRP levels?

Thank you so very much in advance for your time.
Sincerely;  Amy

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by Enoch Choi, MDBlank, Nov 14, 2008
Dear Amy, go see your doctor. A CK and CPK test may be considered.

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by Me967, Nov 14, 2008
Hi Dr. Choi. Thank you first of all for replying to start.  Sorry for my ignorance but, what is CK and CPK for?  Does it deal with the Statins, Thyroid, Heart, Muscles or ?  LOL  Just curious why.  Sorry again for my ignorance.

These issues with the weird winter pains and spasms have been going on for ~4 years now.  They don't seem to bother me that much when the weather gets warmer though.  While the weather is cold though.....O My.  My back x-rays just show some spurring at the L4 level anteriorly; but the disc are fine.

Concerning the heart I have chest pains, palps, SOB and (?) back spasms/pains.  My EKG's I think all lie.  LOL  They sound terrible.  But I don't trust them that much anyhow.  I have had some past issues but the SPECT Stress test I had done well on and reached my goal within 4 minutes and Echo at the time was ok.

I was trying to blame this on thyroid but it seems my numbers are not that bad or too low.  A friend of mine said maybe the adrenals? ???  Then I thought maybe Lipitor in which brought me to you.

LOL  Even I think it all sounds crazy but trust me the pains are real.  Thank you so very much for your time.  If you could let me know what I would be asking about (CK and CPK) that would be great.  

Thank you very much;  Amy

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by Enoch Choi, MDBlank, Nov 15, 2008
creatinine kinase
creatinine phosphokinase

tests you need to ask your doctor for, to check on how your muscles are doing

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by Jeff101, Dec 04, 2008
Does crestor raise the HDL levels? I was taking Niaspan but the side effects at the 1000 mlg level were too severe,I was also taking 20 mlg of lipitor. The Lipitor worked fine so my doctor prescribed 10 mlg of crestor instead of niaspan and took me off the lipitor--my main concern is the HDL increase if any.





Thank You ; Jeff





















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by mike5942, Dec 12, 2008
Dr Choi:

I am 50 yrs old, have total cholesterol 220,and High blood pressure. My father and all 4 uncles died of heart attacks, one was in his late 30s and one in his 40s. I am a little overweight, and am unable to exercise effectively due to a torn meniscus and a hernia. It seems to me that I should be able to get some form of statins paid for by HMO. Does this sound reasonable?

Mike59

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by mike5942, Dec 12, 2008
Dr Choi:

I forgot to say in the preceding email that I asked my GP for a CRP test and he said he doesnt belive in the value of CRP testing. Should I change doctors, or be more agressive in asking for the CRP test?

Thanks

Mike

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by quiact, Dec 17, 2008
Facts Believed to be Associated With All Statin Medications:

Adverse events associated with the statin class of pharmaceuticals are thought to occur more often than they are reported- with high doses of statins prescribed to patients in particular.  However, ince this class of drugs has existed for use for over 20 years, statins are considered safe and effective for enhancing the clearance of LDL noted to be elevated in the lipid profiles of patients.
Additionally, there is no reduction in cardiovascular morbidity or mortality, as well as an increase in a person’s lifespan, if one is on any particular statin medication for their lipid management over another, others have conclusion.  So caution should perhaps be considered if one chooses to prescribe such a drug for a patient if they are absent of dyslipidemia to a significant degree, or are under the belief that one statin medication provides a greater cardiovascular benefit over another.  In other words, the health care provider should be assured that any statin therapy for their patients is considered reasonable and necessary if the LDL in their patients need to be reduced perhaps at this time with the evidence that exists regarding statins.
Abstract etiologies for those who choose to prescribe statin drugs on occasion for unindicated reasons , such as reducing CRP levels, or for Alzheimer’s treatment,  or anything else not involved with LDL reduction may not appropriate prophylaxis at this point for any patient.  All other benefits that appear to have favorable effects in such areas are speculative at this point, and require further research for disease states aside from dyslipidemia, according to many.
Statins as a particular class of drugs that seem to in fact decrease the risk of cardiovascular events significantly, it has been proven.  This may be due to the fact that statins improve endothelial function as well as they also have the ability to stabilize coronary artery plaques, which prevents myocardial infarctions.  Statins also decrease thrombus formation as well as modulate inflammatory responses (CRP).  For those patients with dyslipidemia who are placed on a statin, the effects of that statin on reducing a patient’s LDL level can be measured with the efficacy of the statin after about five weeks of therapy on a particular statin drug.  Liver Function blood tests are recommended for those patients on continued statin therapy, and most are chronically taking statins for the rest of their lives to manage their lipid profile in regards to maintaining the suitable LDL level for a particular patient presently.
As stated previously, in regards to other uses of statins besides just LDL reduction, there is evidence to suggest that statins have other benefits besides lowering LDL, such as reducing inflammation (CRP) with patients on statin therapy, those patients with dementia or Parkinson's disease may benefit from statin medication, as well as those patients who may have certain types of cancer or even cataracts.  Yet again, these other roles for statin therapy have only been minimally explored, comparatively speaking.  Because of the limited evidence regarding additional benefits of statins, the drug should again be prescribed for those with dyslipidemia only at this time involving elevated LDL levels as detected in the patient’s bloodstream.

Yet overall, the existing cholesterol lowering recommendations or guidelines should be re-evaluated, as they may be over-exaggerated upon tacit suggestions from the makers of statins to those who create these current lipid lowering guidelines.  This is notable if one chooses to compare these cholesterol guidelines with others in the past.  The cholesterol guidelines that exist now are considered by many health care providers and experts to be rather unreasonable, unnecessary, and possibly detrimental to a patient’s health, according to others.  Yet statins are beneficial medications for those many people that exist with elevated LDL levels that can cause cardiovascular events to occur because of this abnormality.  What that ideal LDL level is may have yet to be empirically determined.
Finally, a focus on children and their lifestyles should be amplified so their arteries do not become those of one who is middle-aged, and this may prevent them from being candidates for statin therapy now and in the future, regarding the high cholesterol issue.
Dietary management should be the first consideration in regards to correcting lipid dysfunctions,

Dan Abshear



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by Blossum1954, Sep 01, 2011
My son is 38 years old. Family history on paternal side of High BP. He went to ER last night with a BP of 226/118 anf heart rate of 42. Has been on Lisinipril 20 and a cholesterol med. ER did nitro pill nder tongue. no chnage in BP. Did heart cath and he had 30% blockage in 3 arteries but they stated not enough to do stints. Question is they sent him home with the same BP and heart rate to follow up with is regular Dr in 2 weeks but prescribed Crestor. Any ideas as to why BP would be so elevated and heart rate so low? His father passed away at age 43 of massive coronary.

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by Blossum1954, Sep 01, 2011
Sorry for mispellings---I phone---grr


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