Short term Statin-use? Good Doctor near Claremont, CA?

March 4, 2009 1:12 PM

Cholesterol / statin filter. 35yr old male. Direct LDL 192. Overall chol 275. My new doctor prescribed Lipitor 'for 3 months' to lower my cholesterol. i) Question about short term statin use. ii) Do know any good primary-care Doctors in the Claremont,CA area? I know you're not my doctor.

I have higher than average LDL: it would probably be a good idea to lower it. However, as far as I understand it, Statins are prescribed for LD Cholesterol reduction chronically. i.e. Once you're on the drug, you need to be on it for good.

The jury's out on the health implications of prolonged statin use: I've no desire to take this drug for the remainder of my (long) life unless absolutely necessary.

I have no other history that would suggest the necessity of statin use : i.e. I have no evidence of high blood pressure, heart disease, or arterial blockage/narrowing ( I've had the occasional non-exercise-induced chest pain since I was 30 which repeated chest X-rays, bloodwork (to test for raised CRP), and EKG came back as normal). The doctor at the time (and my new doctor) suggested it's chest-wall pain or indigestion.

I raised these points about the chronic nature of statin use with my new doctor upon his prescription, but he dismissed them and could not cite any literature that suggested temporary use of these (reversible!) inhibitors would have benefit beyond the time of use. For this reason and others, I'm looking for a new doctor. In the meanwhile,

i) I'd like to know if there's any evidence that acute statin use for a few months lowers cholesterol permanently.

ii) If there is no evidence for this, suggestions for a non chronic regime (drug or otherwise) to lower my LDL in a safe as possible manner.

iii) Know any good primary care doctors in the Claremont , CA Area?

posted by lalochezia to health & fitness (14 comments total)

Also: Not overweight (6"2, 175lbs). Not exercising regularly at the moment , which obviously I'm trying to change.
posted by lalochezia at 1:14 PM on March 4

ii) If there is no evidence for this, suggestions for a non chronic regime (drug or otherwise) to lower my LDL in a safe as possible manner.

Dietary treatment for elevated LDL cholesterol levels.

Then google "vegan cholesterol levels"
posted by trueluk at 1:22 PM on March 4

I'd recommend first reading a bunch of Dr. Eades' blog, especially the posts in the statin category. He's very much opposed to statin use and addresses a number of statin studies from a scientific point-of-view. Also, he just had a really interesting post about a study that showed how a paleo diet can significantly improve lipid profiles in just two weeks.
posted by Durin's Bane at 1:36 PM on March 4 [2 favorites]

Dr. William Davis has lots of info on this and other topics. I was fascinated to read that statins can actually be toxic, and most of the times small changes in diet + some supplementation can reduce cholestorol, sometimes dramatically.

Personal anecdote: my mom's liver was almost destroyed by a course of statins. Fortunately, she realized something was wrong and stopped taking them (under doctor's supervision of course) in time. It still took her a year of taking things easy and avoiding things like tylenol to get her liver back in shape. Fortunately, the liver is one of the organs that can regenerate.
posted by Arthur Dent at 1:39 PM on March 4

Do you have a good idea as to why your cholesterol levels are so high? I think that would be the first step towards making an informed decision as to where to go regarding your current situation.
posted by scarello at 2:06 PM on March 4

Have you had your cholesterol checked regularly? It seems a bit extreme to go directly for statins without lifestyle changes and considering you don't have other risk factors unless you forgot to mention that all your family dies of massive heart attacks before the age of 50. It seems to be some medical fad (maybe drug companies pushing them too hard on doctors?) since I've heard of several other similar cases.

Here's a Mayo clinic guide to help decide if statins are right for you. It says:

You may think that once your cholesterol goes down, you can stop taking medication. But, if your cholesterol levels have decreased as a result of taking a statin, you'll likely need to stay on it indefinitely. If you stop taking it, your cholesterol levels will probably go back up.

The exception may be if you make significant changes to your diet or lose a lot of weight. Substantial lifestyle changes may allow you to maintain low cholesterol without continuing to take the medication, but do so under your doctor's supervision.

There's a lot more info at the Mayo clinic site about foods that lower cholesterol and supplements. Also a podcast on lowering cholesterol without statins.
posted by lucia__is__dada at 2:17 PM on March 4

find a new doctor imo
posted by dougiedd at 3:25 PM on March 4

I'd get another test done. You don't get a diagnosis of anything with just one test. For instance, if you ate a sausage biscuit right before you had the test, your results would probably be higher than if you didn't. All I'm saying is that to confirm results you really need to get the same results more than once. THEN I'd look at a non-medicinal way to approach my elevated cholesterol.
posted by FergieBelle at 4:43 PM on March 4

IANAD.

Statins should only work while you're taking them. Are you sure that this is not a miscommunication, and that it was not your doctor's intent for these three months to be a trial period, to see if they work before placing you on them longer term? While I won't rule out incompetence, more doctors are bad at communication than are bad at medical science. Both of these can be truly harmful, though, so by all means consider switching providers.

If you want to avoid using a statin or other drug, or even if you're not averse to these, dietary modification should be your primary approach. Indeed, this is what your doctor should have suggested first; unfortunately, as few patients take this advice, many physicians go straight to the drugs with only cursory attention to this point. You really should be on a three-month diet trial before starting any drugs.

Finally, don't blanket rule out the drugs. The serious consequences of statin use (e.g. muscle damage, liver problems) are rare and can be mitigated if patient and physician are paying attention, and many people take statins without even minor side effects. If you can't get your cholesterol down through diet, a statin may help to stave off a heart attack many years down the road. The poorly-defined long-term safety profile is a reasonable concern given your age, but do weigh it against the very real risks of many years of high cholesterol.

I'd get another test done ... For instance, if you ate a sausage biscuit right before you had the test, your results would probably be higher than if you didn't.

Huh? While this is true, it is also why routine cholesterol tests are issued after fasting. Repeat testing is a good idea, but it is virtually certain you will be given tests at each regular office visit if your physician is concerned about hypercholesterolemia.
posted by monocyte at 7:03 PM on March 4

IANAD/Anecdotal data point for you: my dad's cholesterol was around 250, and the doctor suggested he try dietary/lifestyle changes before trying a statin, due to the bad effects they can have on your liver. He was able to get his numbers down relatively quickly by eating more fruits/veggies and a lot of flax.

Have you considered seeing a dietitian? I would strongly suggest talking to another doctor or a dietitian about the some dietary changes (in addition to adding exercise) that could help lower your cholesterol. Even small changes would help, and will probably "last longer" in your system as opposed to taking a pill. (Like maybe you slip up and have a few bad days/weeks of eating, my guess is it isn't going to affect your system as much as skipping a pill for two weeks.)
posted by sararah at 8:32 PM on March 4

Find another doctor. This temporary statin business is non-sense as you rightfully suspect.

Ignore anyone (ehem... Eades.. ehem) who proclaims to be a critical reader of the medical literature but finds more fault with statin studies than research published on diet. I assure you the prospects of performing well-controlled, covariate balanced studies on dietary interventions is orders of magnitude more daunting, with comparatively minuscule available positive findings relating to hard end-points.

LDL of 190 or greater is considered very high. The current guidelines for treatment (see ATPIII) suggest that in patients with essentially no other risk factors for a cardiac event, the goal is to bring the LDL down to 160 or below (though some debate exists regarding the concept of therapeutically targeting goal LDLs). These guidelines, the standard of medical care at this time, suggest that for patients with LDL between 160-189, lifestyle changes are an appropriate first step prior to medication, while for those with LDL of 190 or greater, statins are in fact recommended up front. This is based on research suggesting that patients very rarely succeed in reducing their lipids to goal and sustaining such reductions with lifestyle modification alone. Granted, a fair component of that failure has to do more poor compliance than the impact of appropriate diet itself. All that said, there is little harm in ever trying appropriate lifestyle modifications for at least a few months, so I also advocate this in a larger fraction of patients than the guidelines suggest.

In considering the risk/benefit of statins, do keep in mind that the risk of a death or serious, irreversible complication remains vanishingly low, while minor side effects (reversible with drug discontinuation) are more common. Consider this in light of the fact that a 35-year-old man with perfect blood pressure, no smoking history, and no other risk factors other than lipids like yours has an estimated risk of death or heart attack approaching 3% over the next 10 years.

I am not your doctor and all of the above is general information, not to be construed as specific medical advice for your case.
posted by drpynchon at 9:16 PM on March 4 [1 favorite]

A better diet and more exercise are the answers to a WHOLE LOT of health problems. Your doctor would probably just love the hell out of you if you went this route because he probably gets pretty tired of telling people this and them going home and watching TV.

I'm not sure there is anything that is going to change your cholesterol long terms that isn't, itself, going to be long term. It's not some outside agent causing this, it's your body achieving some kind of equilibrium with it's environment.

Once you have plaque on your arteries, it's pretty much gonna stay there despite exercise or statins or what have you. That may change someday. (Google ApoA-I Milano - the project I worked on is pulled over to the side of the road but other companies are still working on this.)

As for short term treatment with statins, the only thing I can come up with is he wants to see if you'll respond enough to even make it worth while. And that's just a vague guess.
posted by Kid Charlemagne at 9:19 PM on March 4

"Also: Not overweight (6"2, 175lbs). Not exercising regularly at the moment , which obviously I'm trying to change."

Yes, you need to gain some muscle mass. 6'2 175 is pretty weak for an otherwise healthy 35-year old.
posted by tiburon at 7:10 AM on March 5

Great advice in this thread. Anecdotal info: My husband lowered his LDL with relatively minor changes to his diet, just in case you think really major changes are needed.
He switched his butter for Flora active, took a Benecol every morning and eat a small bowl of Pecans & Walnuts with breakfast. We have a relatively healthy diet otherwise so he was just a bit more careful with dairy products but after three months of this the blood results came back already improved. Go for it!
posted by Wilder at 6:41 AM on March 6