To Statin, or Not to Statin

[joedelg]

I am 36 years old and have an overall unremarkable medical history. My father had his first triple-bypass surgery when he was 42, a second when he was 56, and succumbed to heart failure at 71. He was a non-smoking, slender man who exercised each day for 45 minutes, from his 30th birthday until his dying day. Both of his parents died of MIs in their late 60s. His sister passed away at 56 due to the same, and one brother who is currently 81 with no history of CAD.

I am committed to prevention as it relates to my heart health and this poor family history and wish to do all possible to avoid this fate. A few years ago, I underwent a high resolution cardiac CT tomography examination. The results indicated that while my calcium score of 10.8 is considered “Mild:, it places me in the 89th percentile for asymptomatic males of my age (88% of men under 40 have a lower calcium score). I view this as at least partial confirmation that I have not eluded my family history for heart disease, though my physician doubts the significance of the finding of this scan.

In brief, my historical lipid averages are 40 for HDLs, 101 for LDLs, Triglycerides are 85, and total cholesterol is 157.

My question, if you would be so kind as to entertain, is my internist would like to place me on statins to improve my lipid profile given the above mentioned history. I already take a low dose of Niaspan to help increase HDLs, but he would like to see my LDLs even lower.

I hesitate, on the other hand, out of concern for taking such a drug for many years (I hope) with minimal necessity given a pretty darn good lipid profile. I know that statins are generally viewed as safe, yet I also know there is little known about the long term effects. I would be extremely grateful to you if you would be willing to tell me what your thoughts are. If I were your patient would you suggest I take the statin or continue on my current course of healthy eating habits, moderate exercise, etc.? Or anything else you might recommend?

Again, thank you.

Joe

[e.r.boy]

Statins are successful at lowering LDL. There is still a cloud of doubt over their efficacy at preventing CAD. They are finding that they have been oversold and that something like 50 people have to take the maximum dose chronically to prevent one cardiac event. There is a study coming out in 2010 comparing taking Niaspan alone, a statin alone, or a combination of the two. I could not tolerate statins because they gave me an arrhythmia, but if you can I would do the 40mg of Crestor daily. In studies it has been shown to stop or slightly reverse plaque. There are lots of people who can tolerate it.

[erijon]

the AHA guidlines reccommeds an LDL under 70 for those individuals with a previous MI or major risk factors such as your family history. Your lipids would look great otherwise. I am on statin  therapy (Vytorten) with similar numbers as yours. I watch my diet and exercise daily, but without the statins I have a difficult time controlling my lipids. It started out of the blue, one test went from TC of 145 one year to 219 the next. I have had no side effects and have had a good handle on my lipids for the past 3 years with my LDL at an all time low of 51.

Also, if you're looking for a doctor's opinion, there are none in this forum, try getting on the expert forum, you can ask a cardiologist or try the Cardiovascular Disease Prevention board, it's great as well and easier to get on.

I hope this helps, good luck.

Jon