Cholesterol-lowering medication: Yes or No?

[BoxingRed]

Considering the research that surfaced a few weeks ago regarding the ineffectiveness of Zetia at preventing atherosclerosis, I'd advise saving your money on an extremely overpriced drug with little clear benefit. Based on that research, you'd be far better off with a prescription niacin, which will not only reduce the bad LDL level but also increase your good HDL level. Plus, it's loads cheaper as well!

Niacin is good for triglycerides and can benefit HDL, but has a minimal effect on LDL(A 10 to 20% reduction). It requires a very large doses and one should consult with their doctor before trying it. There are liver issues with niacin as well and can be very dangerous for alcoholics and people with liver disease. The main side effect is flushing, which may be solved by taking an aspirin (325 mg).

Zetia probably does not work for everyone, but it may be worth a shot if statins aren't working. There are the bile acid sequestrants as well. Our prof seemed to be a proponent of those. The down side is the GI issues.

Not sure how effective Co-Q is at preventing the statin-induced myopathy, but, again, with your doctor's or pharmacist's consent, it seems worth a try if the alternative is abandoning statins altogether. It can have some pro-coagulant effects so be careful if you are on warfarin. Of course, if you are on warfarin you know you have to watch out for a lot of things.

[BoxingRed]

I'm on Lipator. I'm getting muscle aches and pains from it.

I have no empirical evidence to back me up, but I have heard of people having a hard time with one statin and doing better on another.

Just addressing the folks on here that mention the muscle pain, I am wondering how it feels to you? Most of the time, the myopathy of statins have been described to me as being unbearable and different from any pain they have felt before. Is this your experience as well?

[Larkin Fan]

Someone recommended Niacin to me about 20 years ago. He was a vitamin addict and said to take twice the recommended daily dose. I did it for a couple weeks and never went back to it. I don't know if it affected my levels at all, but I was beet red for most of the day and a little warm.

The latest Doctor put on the prescription for Lipator: Take 1/2 tablet daily to prevent Heart Attack. It gets my attention now.

You're talking about over-the-counter Niacin preperations that anyone can buy. What I mentioned are prescription Niacin formulations, which are specifically designed as controlled-release so that they do not cause the flushing effect. Regardless, even with OTC Niacin, the flushing effect can be avoided by simply taking an aspirin or advil to counteract the prostaglandin release.

[Spring~Fields]

Considering the research that surfaced a few weeks ago regarding the ineffectiveness of Zetia at preventing atherosclerosis, I'd advise saving your money on an extremely overpriced drug with little clear benefit. Based on that research, you'd be far better off with a prescription niacin, which will not only reduce the bad LDL level but also increase your good HDL level. Plus, it's loads cheaper as well!

I had read that about niacin on many web sources some were major universities, I can't recall what Mayo or Cleveland clinics said so I won't risk the credibility flaw here. How much of niacin can we safely take and get the positive results that are needed and for how long? For some reason I am really frustrated with the cholestrol thing. I guess maybe it is that most of the foods have ingredients that make it difficult to over come it. Or maybe I am just plain stupid.

[Spring~Fields]

You're talking about over-the-counter Niacin preperations that anyone can buy. What I mentioned are prescription Niacin formulations, which are specifically designed as controlled-release so that they do not cause the flushing effect. Regardless, even with OTC Niacin, the flushing effect can be avoided by simply taking an aspirin or advil to counteract the prostaglandin release.

So if I take a Bayer that flushing that I have right now will stop ?

Should I ask my doctor about presciption Niacin? He is really strong on the statins.

[Larkin Fan]

So if I take a Bayer that flushing that I have right now will stop ?

Should I ask my doctor about presciption Niacin? He is really strong on the statins.

I would definitely talk to you doctor about it. However, with your existing liver issues, it may not be an option for you and I'd be extremely careful about supplementing with OTC niacin without discussing it with your doctor.

[Larkin Fan]

Niacin is good for triglycerides and can benefit HDL, but has a minimal effect on LDL(A 10 to 20% reduction). It requires a very large doses and one should consult with their doctor before trying it. There are liver issues with niacin as well and can be very dangerous for alcoholics and people with liver disease. The main side effect is flushing, which may be solved by taking an aspirin (325 mg).

You neglected to mention that Zetia only results a 10-20% reduction of LDL and it's efficacy in preventing major coronary events has been shown to be non-existent. It's hard to dispute the empirically proven fact that Niacin is the best therapeutic agent that we have for raising HDL levels (by 15-35%). And since HDL is essential for removing LDL from the blood and overall cardiac health, that makes niacin an extremely helpful therapy either alone or in combination with the statins.

[Spring~Fields]

I would definitely talk to you doctor about it. However, with your existing liver issues, it may not be an option for you and I'd be extremely careful about supplementing with OTC niacin without discussing it with your doctor.

Thanks LF, I'll take that under serious advisement.

[BoxingRed]

You neglected to mention that Zetia only results a 10-20% reduction of LDL and it's efficacy in preventing major coronary events has been shown to be non-existent. It's hard to dispute the empirically proven fact that Niacin is the best therapeutic agent that we have for raising HDL levels (by 15-35%). And since HDL is essential for removing LDL from the blood and overall cardiac health, that makes niacin an extremely helpful therapy either alone or in combination with the statins.

Two points, the risk of severe myopathy is much greater when statins are taken with niacin.
Delayed release niacin may be less effective and appear to be more hepatotoxic.

I am no Zetia drug rep, but the study that I saw about Zetia didn't say it was ineffective, it said that the combo of Zetia and simvastatin (Vytorin) was no more effective than simvastatin alone.(And this was only one study). I'd appreciate a link to the journal article you have on the overall ineffectiveness of ezetimibe.

[BoydsOfSummer]

Someone mentioned muscle pain with just Lipitor. That's what I take and haven't noticed any extra pain not related to my increasing age. It keeps my cholesterol in pretty good check and I'm a bit of a naughty boy sometimes with the diet.

[BoxingRed]

Someone mentioned muscle pain with just Lipitor. That's what I take and haven't noticed any extra pain not related to my increasing age. It keeps my cholesterol in pretty good check and I'm a bit of a naughty boy sometimes with the diet.

It's a rare side effect. Literature puts it at about 5% compared to 1.1% on the placebo.

[RedsFan75]

For me Lipitor basically, debilitated me. Not an immediate reaction, one that slowly built over time. It started with just my legs getting tired quickly, to the point I couldn't mow the yard in one go at it. Then It would be I couldn't even walk through Eastgate mall without sitting a couple times. Also I started to strongly consider asking the Dr about the little blue pill that has become so popular with men of a certain age... I started having bad leg cramps for no reason...

This took almost a year to develop into this level of problem. So I talked to my Dr and he took me off Lipitor, and put me on Pravachol, and in a short time I was back to normal.

Stayed on this for quite a while then went to the Dr with what seemed like gout symptoms in my hands and toes, but yet no indication of gout in the tests. He took me off Pravachol and the gout cleared. Put me on Zocor and again after a while a slow build up of pain that made my hands a feet feel like the joints were going to explode, yet no signs of outward swelling. (Somewhere in there I also tried Crestor, can't remember the sequence on that one... ) Dr has now put me on Zetia...

I've tried to explain what I went through for those with muscle aches, but remember I have arthritis, and that may exacerbate issues that wouldn't normally happen to others. My mother also has LOTS of trouble finding a statin she can take, so it may be another genetic issue, who know the body is a strange and marvelous thing and each persons is different. My Rheumatolosigt thought that my reactions to the statins were a bit more extreme than they should be, so YMMV, pay attention to your body, and if you think you have aches because of the drugs, MAKE SURE you talk to your Dr, and gather empirical information, such as are you doing things that normally would have no problem, etc....

[RBA]

Thanks Redsfan75. I'm on Lipator and showing some of the same signs of my legs getting weaker as in running, treadmill, oplitical. I think I will see how it goes into the new year and see my doctor about it if it presist. I don't see me ever having to worry about the 'blue pill'; knock on wood.

[919191]

I've been on simvistatin for about 15 months. It does the job, and I've been symptom free, until recently. I notice lately alot more leg fatigue, but it might be age. I run, do a 9 or 10 mile run once a week, and do speedwork, too. I'm running ok, but I do feel a little different. Might just be age- I turn 50 in the summer.

[BoxingRed]

I've been on simvistatin for about 15 months. It does the job, and I've been symptom free, until recently. I notice lately alot more leg fatigue, but it might be age. I run, do a 9 or 10 mile run once a week, and do speedwork, too. I'm running ok, but I do feel a little different. Might just be age- I turn 50 in the summer.

Might consider adding some weight training with the running as long as your Doc gives the ok. Muscle and the ability for that muscle to bounce back decreases dramatically as we age.

Again, supplements, other drugs, and the biggee, grapefruit juice, should be explored with your doc or pharmacist as possible contributors to any adverse effects of statins. The one thing that is constantly drummed into our heads every day at school is that everything must be examined when it comes to the metabolism of drugs including genetics. The good news is, in as soon as 10 years, I believe your pharmacist will be able to examine your genetic make up and determine proper dosage, potential interactions, problems with metabolism etc. There will be a lot less trial and error.

It would be extremely unusual, I believe, for you not to have any symptoms over 15 months then develop problems with the statin, though I am very intrigued by Red75's situation.(Clearly he has trouble with statins) I don't think fatigue is a usual symptom. Myopathy is more common.