Coreg and Lipitor Interaction Question

[qmtechguy]

I'm approximately 37 and was diagnosed in Jan 04 with a congenital aortic biscuspid valve and aortic stenosis.

I've dropped 50 lbs, changed my diet, exercise daily, and my cardiologist has me on 6.25 mg of Coreg twice a day, and I've been prescribed Lipitor to get my cholesterol under control.

For the lipitor I was started out at 20 mg per day, but over the last year this dosage has been decreased more than once.  Late last year I went from 20 mg to 10 mg a day.  As of April 05, I came back with elevated AST levels on a blood test, and my family doctor decreased my dosage to 10 mg of Lipitor every other day.

Should I continue to take Lipitor after my cholesterol is under control?  My family doctor is urging me to go off the Lipitor, but my cardiologist seems to want me to keep taking it.  Professionals giving a patient conflicting advice can be frustrating and confusing.

I understand that statin type drugs provide benefits for patients with heart disease.  What are the synergistic benefits I can obtain from Lipitor while taking Coreg that directly impact my heart valve?  Does Lipitor extend the life of the valve?  If so, how does the drug do this?  Are there any side effects to my taking Lipitor in such small doses?

Thank you very much for your time.

[Famulus]

Regarding this " although there is a belief in the cardiology communitfy that statins may help slow the progression of aortic stenosis. There are several studies going on now to investigate this."

Here are the results of a concluded study: (they won't be announcing this!)

Reuters Thu Jun 9, 7:54 AM ET
LIPITOR DOES NOT PREVENT NARROWING IN HEART VALVE

The popular cholesterol-reducing drug Lipitor made by Pfizer does not prevent obstruction of the heart valve that leads to the aorta, the body's largest artery, according to recent findings published in the New England Journal of Medicine.

In a study conducted to determine whether the drug, also known under its generic name atorvastatin, did more than just reduce cholesterol, doctors found that Lipitor failed to prevent obstructions that can keep the heart from pumping blood adequately.

The condition, known as calcified aortic stenosis, occurs when a key heart valve narrows or becomes blocked, preventing the heart from pumping blood properly and can manifest itself in spite of reductions of cholesterol levels, according to the study.

Surgery is usually required to fix it.

Aortic stenosis affects 3 percent of adults over 75, making it the most common valve defect in North America and Europe and occurs gradually over several decades. By the time symptoms appear, surgery is typically needed to repair or replace the valve.

As part of the study, 155 volunteers with signs of calcified aortic stenosis were given a placebo or Lipitor, which like other drugs known as statins slow the narrowing of small heart arteries caused by heart disease.

After a little more than two years, the team led by Joanna Cowell of Royal Infirmary in Edinburgh found that the drug brought cholesterol levels down as expected but produced no real improvement as far as obstructions are concerned.

"Aortic stenosis progresses despite intensive reductions in serum cholesterol concentrations," the Cowell team concluded.
The study was funded in part by an educational award from Pfizer, a grant from the British Heart Foundation and the Welcome Trust Clinical Resource Facility in Scotland.

In an editorial in the New England Journal of Medicine, Raphael Rosenhek of the Vienna General Hospital in Austria agreed, saying that prescribing statins "is not justified" unless a patient has another, more established, reason for taking the medicine.

[CCF-M.D.-MJM]

Hi qmtechguy,

The reason you are getting conflict advice is because there is not clear data or guidelines to manage this, although there is a belief in the cardiology communitfy that statins may help slow the progression of aortic stenosis.  There are several studies going on now to investigate this.

The indication to stop a statin is for liver enzymes (AST) greater than 5 times normal.  If you liver enzymes are that high, you should indeed stop the statin or consider trying another type of statin.  The need for a statin also depends on other things like your cardiac risk factors and your cholesterol prior to starting the statin.

I am not aware of a synergistic benefit between coreg and lipator.

Again, there is no clear benefit of a coreg in slowing the progression of aortic stensis with bicuspid aortic valves.  The real goal should be controlling your blood pressure if your blood pressure is too high.

There is no direct evidence yet that statins like lipator increase the life of a valve.


Your liver enzymes may or may not improve on lower dose statin.  The real question is do your liver enzymes matter if they are elevated less than 5 times normal.  The safest thing to do is let your cardiologist manage your statin with your input.

I hope this helps.  Good luck.