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Old 01-21-2008, 08:43 AM   #21
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Can these serious problems be detected before they do permanent harm?
What tests and at what time intervals should they be done in the startup
period and at what point can you monitor only annually?
Blood tests can detect liver and muscle problems early, while they are highly reversible. There are rare cases where such problems arise seemingly suddenly and irreversibly. I have not seen such a case ever. Liver problems usually occur within the first 3 months.

Once stable, annual follow-ups are what I do.
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Old 01-21-2008, 08:44 AM   #22
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If zetia sucks and statins suck...
Heart attacks suck.
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Old 01-21-2008, 10:11 AM   #23
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But note that in cultures with very low incidence of heart attacks, normal cholesterols often range in the low 100s or less. So maybe our "normal" is set too high. That's not to say everyone needs statins, just that what we consider normal may in fact carry some excessive risk.
IMHO, our "normal" --whatever that is - is what it is because of our diets. People in those countries, assuming you are talking primarily about Asia, eat a primarily vegetarian/fish diet and are quite lean. The question remains for me: is a statin-lowered cholesterol number really preventative if the person doesn't change his/her diet and continues to be overweight?

I realized this is a question that research hasn't answered yet, which is part of the delimma. I think that our medical culture tends to throw pharmaceuticals at medical problems to mask the symptoms when the only "cure" is to change the fundamental cause, if it can be determined.

But I also realize that physicians can't very often take the time to guide a patient through drastic lifestyle changes.
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Old 01-21-2008, 10:40 AM   #24
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NORDS! Come to your senses <slap upside the head>: your risk is 3% for TEN years.
Wanna trade?
Phew, OK, I read the full text. I got sidetracked by that one-year statistic. Thanks for the well-deserved percussive recalibration.

Whatta relief. [Gilda Radner]"Oh. Never mind!!"[/Gilda Radner]

See you guys later; I'll be surfing... with chocolate ice cream to follow.
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Old 01-21-2008, 01:48 PM   #25
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Heart attacks suck.
I'll take YOUR word for it.........I prefer not to experience that first-hand..........
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Old 01-21-2008, 01:55 PM   #26
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I hoped statins helped ward off alzheimers, now we have this:

http://www.dana.org/news/features/detail.aspx?id=10598

Zocor got the best review. "Although follow-up studies produced conflicting results, the picture seemed to clear last year with a report that linked a strongly reduced incidence of Alzheimer's to only one statin, simvastatin (brand name Zocor)."
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Old 01-21-2008, 03:14 PM   #27
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Statins....

I think the real issue here is diet and exercise. Lets be real here, the processed food the fast food the garbage we put into our systems is the cause of heart disease. Sure the genetics does not help in many families. BUT lets stop eating the cr@p, lets all exercise lets all eat Many less calories, lets all lose weight live less stressful lives and stop being all worried about the Numbers from the fasting lipid profiles.

Sure someone will say easy for you mr newguy, but really do we want to be on a drug that is well suspect? That is statistically showing an insignificant reduction in heart events ? Who took Graduate Statistics?? You know what I mean then about statistical significance of anything.
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Old 01-21-2008, 03:45 PM   #28
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Statins....

I think the real issue here is diet and exercise. Lets be real here, the processed food the fast food the garbage we put into our systems is the cause of heart disease. Sure the genetics does not help in many families. BUT lets stop eating the cr@p, lets all exercise lets all eat Many less calories, lets all lose weight live less stressful lives and stop being all worried about the Numbers from the fasting lipid profiles.

Sure someone will say easy for you mr newguy, but really do we want to be on a drug that is well suspect? That is statistically showing an insignificant reduction in heart events ? Who took Graduate Statistics?? You know what I mean then about statistical significance of anything.
Rich will be along to strike me down shortly, but the fact is doctors are trained in medical school to treat CHRONIC illnesses, NOT provide PREVENTATIVE treatments. My dad, the retired pharmacist, used to say doctor's visits usually ended up with the doctor "reaching for the prescription pad" ...........

I think the medical community has done unbelievable things with chronically sick people, they live WAY longer than sick people 20 years ago. But, as far as reducing the number of sick people, little has been done, because the public would rather "take a pill" than exercise 3 times a week.............
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Old 01-21-2008, 04:38 PM   #29
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Originally Posted by newguy888 View Post
Statins....

I think the real issue here is diet and exercise. Lets be real here, the processed food the fast food the garbage we put into our systems is the cause of heart disease. Sure the genetics does not help in many families. BUT lets stop eating the cr@p, lets all exercise lets all eat Many less calories, lets all lose weight live less stressful lives and stop being all worried about the Numbers from the fasting lipid profiles.

Sure someone will say easy for you mr newguy, but really do we want to be on a drug that is well suspect? That is statistically showing an insignificant reduction in heart events ? Who took Graduate Statistics?? You know what I mean then about statistical significance of anything.
I agree with your comment that diet and exercise are key.
You would not believe how poorly patients comply with that advice.
Then you can let them continue their evil ways and die young, or you can treat them.

You should also be aware that there are many others out there with genetic high cholesterols despite lifestyle issues.

I also disagree with your statement that the reduction in heart attacks in properly selected patients is statistically insignificant. It is convincingly statistically significant. However, it is not large on a year by year basis. However, if you add up 15 years of 1% reduction it starts to get my attention.

Glad you don't need medication.

Not directed at you, Newguy, but as a general observation: the smugness of the healthy melts like butter on toast the moment major illness strikes. I've seen it a thousand times.
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Old 01-21-2008, 04:48 PM   #30
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I agree with your comment that diet and exercise are key.
You would not believe how poorly patients comply with that advice.
Then you can let them continue their evil ways and die young, or you can treat them.

You should also be aware that there are many others out there with genetic high cholesterols despite lifestyle issues.

I also disagree with your statement that the reduction in heart attacks in properly selected patients is statistically insignificant. It is convincingly statistically significant. However, it is not large on a year by year basis. However, if you add up 15 years of 1% reduction it starts to get my attention.

Glad you don't need medication.

Not directed at you, Newguy, but as a general observation: the smugness of the healthy melts like butter on toast the moment major illness strikes. I've seen it a thousand times.

Oh Doc, no smugness intended here. I have seen the patients you speak of not wanting to exercise and eat right. Wife spent 25 years as an ICU nurse, Daughter is a physican and yes I believe I am nothing more than human, spent that three days in the ICU back in 01 with Viral pericarditis yes I know what you speak of.

I have a problem with the drug companies fudging the truth, the advertisements the hey YOU NEED A STATIN, that is why I may sound smug and its not intended. As a physical education and health teacher for 30 years and been running for 40 I know really no other way. I remember as a kid I would hate the nights we had steak for diner, that fat and grease well just didn't do it for me. I loved the days of veggies and salads, potatos and pasta, COD and Salmon. I liked Tuna sandwiches and sardines. Who knew!

Oh and by the way that night that I was transported to the hospital in that emts rig thinking I was having an MI I had an oddly calm and collected feeling, like $hit I exercised the heck out of myself all of those years and ate the right things and said oh well if this is it oh well I took a deep breath and waited for the other shoe to drop, but on the floroscope table watching the cardiac cath and seeing and hearing well your arteries are clear and I am not sure what is going on but you are not having a heart attack I well felt relieved. I still remember the days and know there is a higher power out there. No way am I feeling superior.
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Old 01-21-2008, 04:58 PM   #31
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I have a problem with the drug companies fudging the truth, the advertisements the hey YOU NEED A STATIN...
Yup, you get it.
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Old 01-21-2008, 11:16 PM   #32
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Total Cholesterol: 117 mg/dL (130 was the lowest allowed in calculator)
HDL Cholesterol: 40 mg/dL
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Risk Score 4%

The lowest that I could make the calculator go for my age was 3% - I presume that is background noise - factors not known or calcualted.
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Old 01-22-2008, 08:13 AM   #33
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The lowest that I could make the calculator go for my age was 3% - I presume that is background noise - factors not known or calcualted.
Right. A surprising number of first-time heart attack victims have absolutely no identifiable risk factors (up to half in some studies).
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Old 01-22-2008, 10:04 AM   #34
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I must have been going to the wrong doctors for the last three decades or so. I've never ever seen one whip out a calculator, let alone do math...
My internist, the retired nuclear sub commander, uses math, charts, stats, and even calculators during all my visits. He was an EE and I'm a comp sci major, so he feels comfortable doing that with me.

As we all know, Nuke sub cmdrs are always right because they don't make you a nuke sub cmdr unless you are always right...

He doesn't like it when I point out errors.

Mike D.
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Old 01-22-2008, 01:04 PM   #35
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Right. A surprising number of first-time heart attack victims have absolutely no identifiable risk factors (up to half in some studies).
Just want to say (from personal experience) that avoiding a heart attack is a really big deal. [If I could spend 1% more from my portfolio, it would be a very big deal....]

After my cardio "event" I had a treadmill test from a cardiologist outside of my usual team. I asked her if she had a lot of patients like me, who realized they had a cardio problem because of measurable reduced ability on the treadmill at the gym. She said, "no, I don't have any patients like that, they either don't exercise at all or they die outright."
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Old 01-22-2008, 04:40 PM   #36
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Another interesting NYTimes article about statins published today 1/22--
"Vytorin, by combining Zocor and Zetia, produces a bigger drop in cholesterol than either drug could do alone, and without a marked increase in side effects. The problem is that there are no long-term studies showing that using the drug translates into fewer heart attacks or strokes."

And, true to form, the drug company dragged its feet releasing the results of the failed trial and only in a PR release not a medical journal.
Zetia - Cholesterol - Drug Trials - Heart - Medicine and Health - New York Times

Also, from a NYT article on 1/17
"Then, on Monday, Merck and Schering-Plough announced that Vytorin, which combines Zetia with Zocor, had failed to reduce the growth of fatty arterial plaque in a trial of 720 patients. In fact, patients taking Vytorin actually had more plaque growth than those who took Zocor alone."

http://www.nytimes.com/2008/01/17/bu...tml?ref=health
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Old 01-22-2008, 11:44 PM   #37
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As we all know, Nuke sub cmdrs are always right because they don't make you a nuke sub cmdr unless you are always right...
He must've felt that he didn't suffer enough during his first career.

Or else he's a really slow learner!
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Old 01-24-2008, 08:00 AM   #38
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I'm 43 and have taken Lescol for 7 years. Heart attacks run in the family. My father had one at 43 and is still going at 67. My brother died at 34 from a heart attack, and my Grandfather at 60.

My total and LDL are fine but my body does not make HDL. It's very low. I run, eat a very low fat diet and do not smoke. I've tried Niacan for the HDL but no help. My doctor said that's the breaks and just keep doing what you are doing. I had a heart scan and the results were great. I will take the statins until I die. Every little bit helps. I want to see me kids grow up!!
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Allergy to Rx and blood tests
Old 01-24-2008, 08:46 AM   #39
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Allergy to Rx and blood tests

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Blood tests can detect liver and muscle problems early, while they are highly reversible. There are rare cases where such problems arise seemingly suddenly and irreversibly. I have not seen such a case ever. Liver problems usually occur within the first 3 months.

Once stable, annual follow-ups are what I do.
Rich, thanks for the quick reply. The reason I asked the original question was that I have always (or at least longer than my memory which is not so long these days) had elevated GGT. Because of that, my doc (when he was my new doc) said he wanted to treat my mild hypertension but was reluctant to because of possible liver issues. Some years later, either he changed his mind or saw new data and suggested the lowest dose of Lotensin (ACE inhibitor). Fortunately I remembered his earlier thoughts and extorted from him the bargain that I would try it if he would monitor at my demand. Fortunately he agreed. A week after I started (or perhaps 2), after the first lab test came a frantic call to stop taking the medication. I don't recall all of the details but many of the liver function tests,including GGT, had skyrocketed. No symptoms except for the blood test. After stopping Lotension, the tests returned to my normal in a few wks?/mos? and switching to another class of medication was uneventful.

Now, of course, I have become semi-paranoid about any new medication.......and the monitoring schedule for it.
Thus the reason for the original question. I always have this worry that, no matter what monitoring schedule I demand, the problem will surface just after we get comfortable and settle into some longer term regime. Probably silly but I have some history. If we had gone for a 1st monitoring point of 3 mos. instead of 1 or 2 wks as the first monitoring point, how much of a problem could that have created?
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Old 01-24-2008, 10:15 AM   #40
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i fail to understand why anyone would introduce into their bodies a chemical to supposedly correct a problem fixed simply by diet.

it is like eating antacids just so you can eat a hot pepper which burns your mouth and stomach.

when the choice is giving up chopped liver or take statins and risk your own liver instead and you choose to continue eating animal fat, you really ought to question, before you pop that pill, just how concerned you are with your own health.
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