Practical Practitioner
By: Pamela Egan, FNP-C CDE
Benefits of cholesterol medication outweigh the risks
Dear Pam,
I saw an attorney’s ad in the newspaper regarding a suit for damages from cholesterol medications. Should I stop my Pravachol?
These attorneys tend to focus on the very small percentage of patients who may have had an adverse occurance from a medication. What they fail to focus on is the huge number of patients who have prevented strokes and heart attacks by taking statins. If you look at the statistics over the years, the age at time of death has greatly increased because of these types of medications.
Self-responsibility is essential in health. The days where the doctor tells you what to do with no questions asked is gone.
Patients should determine if a medication is right for them after weighing all risks versus benefits. Only after a discussion with your healthcare provider and pharmacist should you take medication.
No medication is flawless. There is not one medication in the Physicians Desk Reference without side-effects.
One way of looking at it is, would you prefer to monitor your labs as recommended and prevent a stroke that would leave you bed bound for the rest of your life or not take the medication for fear of myopathy and have a massive heart attack at a young age? No one knows who will react badly to a medication, but the goal to improve and lengthen one’s life is a health care providers intention.
There’s a lot of confusion about lab tests for patients getting a statin (Lipitor, Zocor, Pravachol). The American College of Cardiology, American Heart Association and National Institutes of Health have jointly come out with a new consensus. You should know what is recommended and ask for appropriate labs when they are due.
Creatinine kinase is recommended at baseline for all patients. This is the test that measures myopathy or muscle pain. However, many patients have elevated levels even without myopathy. Routine creatine kinase monitoring is not recommended. Only those who develop symptoms of myopathy should be checked. For those whose level is 10 times or more above normal, the statin should be stopped. If elevations are less than 10 times above normal, you don’t have to stop the statin, but monitor weekly.
If levels are gradually increasing, consider reducing the dose or temporarily stopping the statin.
Hypothyroidism increases the risk of myopathy. Thyroid levels should be checked if you develop muscle pain. Several other medical and health conditions put patients at risk for myopathy such as older age, multiple conditions, higher statin doses and drug interactions.
Liver function tests (ALT and AST) are recommended by all the statin manufacturers. LFT’s should be checked when a statin is started, again in 12 weeks and annually thereafter. If levels are three times normal, the statin does not have to be stopped but continued monitoring is recommended.
Elevated LFT’s occur in less than 2 percent of patients and usually normalize with a lower dose. Liver damage is rare if it occurs at all.
For those who can’t take statins, the health column a few weeks ago cited the study from the Cleveland Clinic showing that Bios Life 2 (fiber and B vitamins) by Rexall Drugs, also reduces cholesterol.
This article was originally published September 24, 2002 in The St. Tammany News.
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