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Doctors' Answers to "Frequently Asked Questions" - Cholesterol
High Cholesterol and Birth
Control [posted 1/11/99]
Answer: I doubt that the birth control pills were the problem. Restart them and see what happens to your cholesterol.
Mylanta/Zantac effects on
Cholesterol [posted 1/7/99]
Answer: Wouldn't think so, but you can experiment by stopping it for a month and see.
Cholesterol Medications &
Elevated CPK [posted 12/10/98]
Answer: Most physicians and the company would recommend stopping the HMG Co A Reductase drugs if you have an elevation of CPK. Usually, bigger doses of Questran will work. Also, Lopid should not have this interaction.
Cholesterol & Problems [posted
Answer: Most physicians would treat you with some lowering agent with your family history and your low LDL. As to the risk/benefit, this is currently under research by the NIH. This is an area which has been neglected by the NIH. I would recommend treatment until further research comes in;but, would not push the dosage and warch closely for toxicity. Also, Vitamin E(400 units or so a day) might be a benefit. This has been shown to reduce cardiac risk without much/any toxicity. This issue is a style thing-some physicians would treat some not until more data is available. With your family, I would opt for treatment. Also, you might check your homocysteine levels-if elevated might be an additional factor to consider. Lastly, unless there is a high risk of breast cancer, you need to be on estrogen when you hit menopause.
High Cholesterol & High
Triglycerides [posted 12/01/98]
Answer: Well, I think lowering triglycerides is pointless unless they are above 2,000 (which gives a risk of pancreatitis). Not every physician would agree with me. But Framingham data shows minimal correlation between elevated trigs and coronary artery disease. However, if you need to lower your trigs you need to monitor it closely for the first 6-9 months, then you can usually lower the frequency of monitoring unless you increase your dosage. The tests are correct and the frequency correct. But, the frequency will decrease over time(for most physicians).
High Cholesterol [posted
Answer: A cholesterol of 197 isn't bad; but, could be better. The problem is that your LDL(bad) cholesterol is high relative to your HDL(good) cholesterol. Exercise and losing weight will improve these numbers from just OK to very good.
Lipitor & Chlosterol
Answer: The options for lowering cholesterol are losing weight and strict fat restriction in the diet. This can lower cholesterol-short of this you're in for the duration. You might be able to lower costs by buying the 20 mg and cutting them in half. This is certainly true in the states. Also, check the price in Mexico. Many of my patients go to Mexico to fill Rxs for cheaper.
Answer: Doesn't seem to be. Very high levels like 5.5-6.0 can cause a problem;
but, less likely if it is chronic versus acute. The kidneys are already functioning at
less than 100% to get this level of Creatinine. A normal creatinine is up to 1.6 or so.
This is high-although still a way from dialysis. This would indicate either an outlet
problem with your prostate or flow limitation due to vascular disease to the kidneys.
Other causes would include the use of ACE inhibitors or excessive diuretics. I'd check on
the kidney issue-the potassium is not a big deal and probably will correct if your kidneys
start to work better.
Lowering Cholesterol [posted
Answer: Questran or lopid.
Family History of High Cholesterol [posted
Answer:I would take the medication with your family history. But, also, is there a history of strokes etc or cardiac disease in those affected and what is the "good" cholesterol or HDL. All would be a factor. The long term side effects appear minimal.
An Aspirin a Day? [posted
Answer: Generally for men over 50, maybe 40. The risk is GI bleeding, gastritis and the like, so use a coated or buffered aspirin. 81 mg(baby) to 325 mg would be the dosage. More is not better. If you have no history of GI problems with aspirin probably worth taking. Something, I recommend for all men over 50(over 40 with high risks)-doesn't have the same benefit in women by the way.
Triglycerides [posted 10/21/98]
Answer: What was her cholesterol levels? Does she have other risk factors-diabetes, hypertension etc. Lastly, was this taken fasting since triglycerides are very affected by dietary intake(as opposed to cholesterol levels). Many physicians would not treat elevated triglycerides unless they are several thousand since they are a minimal risk factor for coronary artery disease. Others disagree and would treat any elevation-this is one area that varies a lot. Weight loss and diet will often fix this problem. I would recheck the triglycerides fasting and not treat them if they are below 300 (maybe 500 depending on her other risks)-but, I wouldn't argue with physicians who would treat them
Cutting Pill in Half Yourself
Answer: A lot of my patients save big $$$ by cutting a 40 in 1/2-go for it.
Cholesterol Testing [posted
Answer:These tests are not accurate enough to proscribe treatment. They are accurate enough for screening. I would not use these tests to add/delete medications. Discuss this with your physician;but, you need a more accurate test if you are being medicated.
High Cholesterol [posted 8/4/98]
Answer: The lower the better. You should be aiming for LDL of less than 160. This is insufficient treatment. Better more effective drugs would be zocor or lipitor. Pravachol would be unlikely to lower your LDL sufficiently to achieve the goal of 160. If large doses of zocor/lipitor do not achieve this - add a drug like Questran . This can be combined easily with the HMG-CoA drugs without side effects. If you cannot tolerate the GI side effects of Questran, I would use Lopid instead of niacin, but close monitoring of liver functions would be necessary. You are currently undertreated by a lot. As to your sons, there is a big split in medical circles concerning the optimum time to start their treatment. Some advocate early treatment with medications. Others state that harm can be done to their growth cycle by lowering cholesterol levels and that it should be delayed until 18 or so. There is no current answer to this problem. I think it reasonable to do either until more research is done. However, clearly start them at 18 or so and emphasize the diet/exercise regimen that you are adhering to. Lastly, screen for any other cardiac risk factors regularly, BP, diabetes and even things like homocysteine levels to ensure that cholesterol is your only risk factor.
Cholesterol lowering drugs and
Answer: I haven't seen this as a problem with this drug or its cousins. You can get specific information from the company Merck at: 800-672-6372.
Cholesterol - Zocor vs. Lipitor
Answer: The major difference is the specificity/affinity for the enzyme that the drug is inhibiting. Lipitor is more potent, but judge by your cholesterol. This problem comes up all the time and frankly it doesn't seem to matter if your cholesterol doesn't change. There may be a slightly higher risk of liver toxicity, so monitor your enzymes. Switch and see what your levels are.
Cholesterol Lowering Medications
Answer: They are both very effective with minimal to no long term side effects. Lipitor is slightly more efficient, but this can be compensated by increasing the Zocor dosage. I use both and it is usually a cost issue. Zocor comes in 40 mg tablets which can be cut in half since the price is similar to the 20 mg. This is very cost effective. If it doesn't matter about cost, flip a coin. However, I would lean towards Lipitor slightly.
High Cholesterol Drug Treatment
Answer: Yes - there are several. First, a high fiber diet will reduce cholesterol and in some patients taking metamucil and/or citrucel will help 5% or so at best. Secondly, there is niacin. This is a vitamin, and in large doses (1000-1500 mg) will reduce cholesterol. It is usually available in a slow release format since taking it without the time release really produces flushing and occasional diarrhea. Taking does over 750 mg a day can cause liver inflammation or damage and you should have regular liver function test. This can be increased to 2000 mg a day IF (notice a big IF) you closely monitor liver functions.
High Cholesterol Treatment
Answer: It depends a lot on her HDL(good) cholesterol and her family history. If the HDL is above 65 or 75 and no women in her family have a history of strokes or heart attacks, I'd just have her watch her diet. Diet means low fat and losing weight to improve the cholesterol. If her HDL is below 50, I'd treat her with medications if diet doesn't improve her condition.
Answer: I have over 500 patients on this class of drug and have not seen this side effect. These HMG-CoA reductase drugs are the most effective and I'd try them again. The newest one Lipitor is the most effective for the least milligrams and I'd try it first. If it doesn't work, the binding resins like Questran have the least systemic side effects since they do not get absorbed into the body. They will cause abdominal gas, distention, etc., but will not cause any CNS side effects.
My results on 5/24/94 were as follows: Triglycerides 317 mg/dl Cholesterol 270 mg/dl My results on 6/20/94 were as follows: Triglycerides 209 mg/dl Cholesterol 320 mg/dl HDL cholesterol 45 mg/dl LDL cholesterol 242 mg/dl The results on the following dates were: 02/08/94 09/06/94 06/17/95 04/03/96 S. Cholesterol 307 mg/dl 242 mg/dl 258 mg/dl 299 mg/dl Total lipids 1100 mg/dl 930 mg/dl 770 mg/dl 1219 mg/dl HDL 46 mg/dl 49 mg/dl 37 mg/dl 35 mg/dl LDL 242 mg/dl 171 mg/dl 198 mg/dl 231 mg/dl I took zocor tablets for 30 days (1 full tablet daily) and a half tablet daily after 30 days for fifteen days and results were as follows: Date: 06/11/96 S. Cholesterol 168 mg/dl Total lipids 659 mg/dl HDL 46 mg/dl LDL 106 mg/dl After these results of 06/11/96, I stopped taking zocor due to which my cholesterol results were as follows: 07/22/96 08/17/96 01/08/97 S. Cholesterol 212 mg/dl 227 mg/dl 277 mg/dl Lipids 983 mg/dl 1050 mg/dl 753 mg/dl HDL 41 mg/dl 40 mg/dl 46 mg/dl LDL 151 mg/dl 147 mg/dl 224 mg/dl After the results of 01/08/97, I again took zocor tablets (half tablet daily of 10 mg) for 18 days and my results are as follows: Date: 01/25/97 S. Cholesterol 174 mg/dl Lipids 814 mg/dl HDL 50 mg/dl LDL 112 mg/dl
I am worried that as soon as I take zocor my cholesterol level will shoot up even though I play tennis regularly. Please advise me as to what I should do to control my cholesterol levels and whether I should continue taking zocor. If applicable, please recommend some other medication.
Answer: These numbers pretty clearly show that your cholesterol is low on zocor and high when you stop it. Zocor is only effective when you take it. If it is stopped the cholesterol will regain its usual value within 24-36 hours. Zocor works by inhibiting one of the enzymes that "turns on" cholesterol. So if you stop the inhibition everything reverts to normal states. Zocor is one of the most effective agents and is clearly working for you. However, you have to take it for it to continue to work.
Answer: Risk factors are the following 1) Male, which you are 2) Age over 50, which you are approaching. 3) Family History of Coronary Disease before 60. 4) Diabetes Mellitus. 5) Elevated cholesterol (defined as LDL over 130, some say 160). 6) Smoking. 7) Obesity. For each risk factor the risk is multiplicative. You fail to mention what your HDL(good) and LDL(bad) are. If the HDL is above 45-50 I doubt that I would treat this with medications unless you have other risk factors above. If your LDL is above 130, but less than 160, some would advocate treatment. However, this can be diet and weight loss, which is the best place to start before any medical regimen.
Answer: It is relatively safe. There have been problems with liver toxicity, but these can be avoided by periodic liver tests during the first year or two. Most patients have some GI symptoms with this drug (gas, diarrhea, etc.) There does not appear to be long term toxicity except for the mentioned liver. There are significantly more potent drugs than Lescol, but it is very effective for patients with mild elevations like yours. It has also been studied extensively and is a very effective drug.
He also prescribed amitriptyline to help me sleep, but due to the side effects I have chosen not to take it and try natural ways to help me sleep. Are there other similar drugs to help me sleep with less side effects?
I was recently told I have fibromyalgia, but I am not real keen on taking many drugs. I would rather lower my cholesterol naturally, if possible. I am 43 years old and am quite active. I show dogs for a living, but the pain sometimes gets in the way. Do you have any suggestions?
Answer: Unfortunately, I've never heard of Diovan and can't find it listed in any pharmacy text or the PDR. Is this a natural herb? I'd like to hear more, but I'm unable to help you here. Same with Naprelan. Amitriptyline is given to increase stage IV sleep. It is one of the few drugs that I am aware of that increases stage IV sleep. This is thought to be necessary to relax muscles, which is one of the first steps to improving fibromyalgia.
The best natural way to decrease cholesterol is to lose weight. A vegetarian diet and a high fiber diet will also help. There are several books available in any library or book store focused on diet solutions for elevated cholesterol. The American Heart Association will also provide you with dietary assistance.
Answer: Elevated cholesterol levels are certainly a risk factor for vascular disease. Usually a LDL(low density lipoprotein) of greater than 130 is high and over 160 needs treatment. This can be modified somewhat if the HDL (high density lipoprotein) is high. This usually means over 50 and the higher the better. However, other risk factors are very important in determining treatment. For example, a smoking male with a family history of coronary disease will get treated far earlier than a non, smoking female with no family history of vascular disease.
Cholesterol and Blood
Answer: Off hand, I can't figure any correlation between "thick blood" and high cholesterol. Occasionaly patients will have high triglycerides, but this should not effect the clotting. You do not mention your triglycerids, so these should he checked. Any male patient that is at high risk of coronary disease should usually be on one aspirin a day. This will markedly decrease the risk of coronary infarction and stroke. The risk is bleeding from the GI tract. But small doses(a baby aspirin a day) will suffice. I would discuss this with your doctor and get formal clotting times checked.
Answer: Simvastatin and pravastatin are similar drugs used to lower cholesterol. The major difference is cost.
Answer: Any fiber agent will lower cholesterol. This appears to be by the mechanism of slowing absorbtion of fat and making it less accesible to the intestinal wall. These agents have not been technically "approved" by the FDA, but numerous studies have documented the effect. In general, this effect is insufficient to lower high or moderately high cholesterol levels to satisfactory levels. Fiber also has the effect of lowering glucose levels in diabetics by slowing absorbtion.
Answer: I must have 200 patients on this drug or something equivalent and I've never seen anything close to these symptoms. Indeed, I rarely see any side effects. Try stopping the drug and see if the problems resolve. I doubt that the zocor is the main actor here.
Answer: First, lose some weight. Watching your diet without weight loss is
pointless. Second, check for secondary causes of hypercholestemia(other medical conditions
that can cause an elevated cholesterol). These include thyroid disease, occult diabetes
mellitus, and nephritic syndrome(spillage of protein in the urine).
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