Dr. Suggested a Statin - I Said No Thanks

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Jerry1

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Interesting interaction with the cardiologist re: my cholesterol. I recently went for a visit and the conclusion was that the chest pain was due to my high BP and now that my BP is in check, the pain is gone and he didn’t think I had symptoms consistent with a blockage. Also didn’t see the need for a stress test. He did run a cholesterol test though (results below) and to no surprise to me, he recommended a statin. Hard to understand given that my results came back all in range except for my non-HDL cholesterol.

The call was from a clinician and she said Dr. recommends a statin. She said, given my numbers, there’s a 14% chance of having a heart attack in the next ten years. Given what I understand about the side effects of statins and given that my numbers were basically in range, I said I’d pass.

Then, I looked into it more. Mayo Clinic has a cholesterol heart attack calculator. I put in my numbers and it basically agreed with the Dr. that my chances of a heart attack were about 10%. Then comes the fun part that is very irritating to me. The Mayo Clinic calculator has a tab for how your results will change if you take the statin. According to it, taking a statin I will still have an 8% chance of a heart attack. So, taking the statin only reduces my risk by about 2 to 3 percentage points. I feel it’s misleading the way it was presented to me from the Dr. office. There was no mention of the impact of taking the drug. Just the 14% number. There’s no way I’d subject myself to the side effects of a medication for so small of a potential impact. I wonder how many people just follow the advice and deal with the side effects of the statin. And, I wonder if they’d do the same if they understood the actual reduction they’d be looking at by taking it.


Cholesterol Results
Total 186
Triglycerides 118
HDL 42
Non-HDL Cholesterol 144 (High Normal is <130)
LDL 121
Chol/HDL Ratio 4.4
 
I would have declined the statin as well, if I were in your shoes.
The most important ratio is triglycerides divided by HDL, and yours appears to be 2.8.
Ideally, it should be under 3.0, so that's covered (lower is better). I'd like to see the HDL number higher (40 is often considered the minumum "good" range), but that's easily changed with diet.
You definitely have the right idea about looking at absolute risk rather than relative risk. :clap:
 
On my recent trip to Iceland, I realized I forgot my statin at home. I panicked a little and decided to see a doctor so he could write me a script. He said he could but the minimum was 100 pills and I only needed a couple of weeks at most. He then went on to say at 70 (may have been 75), the impact is very little. In fact he went on to say in Iceland, he would have stopped my prescription. Sounds a lot like what you figured out.
 
I have heard podcasts which have discussed the "relative" vs. "absolute" risk reduction in taking a statin. Very eye-opening.

I am going to do the test over at Mayo mentioned by @Jerry1 . I know my total cholesterol is high (I am going to have find my numbers). Due to a history of left arm pain, my PCP is going to have me get a cardiac ultra sound, and depending on the results a calcium score, which is not covered by insurance.

Update #1

Cholesterol Results
Total 194
Triglycerides 98
HDL 63
Non-HDL Cholesterol 131
LDL 111
Chol/HDL Ratio 3.1

Update #2

From the site "This calculator estimates atherosclerotic cardiovascular disease (ASCVD) risk and provides management strategies for patients ages 40 to 75 years, or lifetime risk for patients age 20-39, with LDL levels >70 and <190 mg/dL.

I got a response that my risk could not be calculated (however a calculated risk of 4.1 percent was indicated).

I wonder if it was the same calculator as I did not find an option to add statin treatment. (I did find a second calculator over a Mayo which requested slight different info with some overlap, which also gave me a 4.1 percent risk.)
 
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I declined a suggestion for statin about a year ago. Felt like the doc was prescribing like it was candy. There was no mention of the possible side effects during the suggestion.
 
I wonder how many people just follow the advice and deal with the side effects of the statin.
I would estimate approximately the vast majority.

Good for you for digging into it to actually understand it. Although it can be a lonely existence.
 
I am not a doctor.

Ask for a referral for a Calcium CT Scan. Even if your insurance does not cover it, it only costs about $100. And, you don't have to ingest or be injected with anything to undergo the scan. The result will tell you if you have calcium buildup in your arteries. If you do, it is probably wise to address it.

Also, make an appointment with your doctor and discuss the pros/cons & your thoughts about taking a statin. If he/she isn't willing to spend the time with you, maybe you need to find another doctor.

Have a conversation with chatgpt, perplexity or your favorite AI program. Feed it your results and ask questions. I've found this useful in a number of cases. Obviously, you should verify the results independently, but it will save you a lot of time.
 
I’m confused as to why people seem to be so afraid of statins. What side affects are you afraid of? The majority of people reporting muscle pain issues also reported them in the control group.

I’ve taken Rosuvastin a couple of years.

If someone is hesitant, I’d say start with 5 mg rosuvistatin. That’s half of the minimum recommended dose. You get about 70-80% of the benefits of the 10mg minimum dose. It will likely lower your LDL 30-40%, based on studies. There were no side effects in studies at the 5mg dose.

Before I started taking them I had an LDL that got as high as 180. Within a couple of months I was able to lower it to 120, just by losing weight, aggressively cleaning up diet, plus adding plant sterols. Then I added 5mg crestor and it got down to 75. Results were consistent with studies.

I dropped the plant sterols (they do lower cholesterol but it isn’t clear if they may be harmful in their own right) and slid a bit on my diet, then bumped crestor to 10mg, I’ve been in the 70-85 LDL range.

If you were initially at 14% risk over 10 years, and statins drop it to 8%, that’s not trivial. Assuming you hope to live over 10 years, the risks increase substantially if you go out 30 years.

What finally caused me to hit the bullet was getting a coronary calcium test and it was about 160. If you got the test and the result was zero then yeah, maybe skip the statin.
 
Obviously this isn't as good as the Mayo calculator but I thought it interesting. The NNT is the number needed to treat. Statins for Heart Disease Prevention (Without Prior Heart Disease) – TheNNT

My numbers are worse than yours (last I checked) and cardiologist says I don't need one.

I will say he has been in there poking around with his camera and knows exactly what it looks like. . . he said some people just don't accumulate bad things in the wrong places (paraphrasing obviously but that is what I recall now).

I won't be taking one unless I've had a heart attack already.
 
A lot to think about. For what it's worth, there are a number of doctors on YouTube who say cholesterol numbers aren't a good gauge and statins should be avoided. It's hard to know whom to believe.

My numbers were similar to the OP (some higher, some lower), and my doctor said she "was willing" to prescribe stations. I said no because my noncholesterol numbers all looked good, I eat well, I exercise, and my weight is normal.

However, there's little doubt that, based on family history, my biggest concern is cardio health. An acquaintance who seemed healthy nearly died after a heart attack some months ago, and he's since proselytized for the calcium CT scan. My current sense is, as others have said here, it's best to have the scan and then decide on the appropriate action. I think I'll aim to get one next year after I turn 65.
 
Ask for a referral for a Calcium CT Scan. Even if your insurance does not cover it, it only costs about $100. And, you don't have to ingest or be injected with anything to undergo the scan.
Can’t be that cheap. Can it? My insurance copay for a CT scan is a few hundred dollars.
 
I’m confused as to why people seem to be so afraid of statins. What side affects are you afraid of?
I have a general policy of trying to avoid all medication. Of course there have been some that I have to take now with my current illness or I wouldn’t be alive, but as a rule, I start with not wanting to take any medication. The side effects are always a consideration. Historically, in my life, if there’s a side effect that isn’t necessarily common, I’ll be one of the lucky one’s. I don’t know much about statins, but my understanding is that it’s preferred that you take CoQ10 with it. That right there makes me feel like it depletes your body of something.

As for the calcium scan, I’ll see my PCP next week and discuss the statin and the scan with him.
 
I second a Calcium CT scan mine was $100 a year ago, no insurance coverage.
I’m not a doctor but I spent 30 years in the pharmaceutical industry.
I too, would probably reject the statin. I take no meds. I’m trying to put pharma out of business, singlehandedly.
However, heart attack is not your only risk. It is postulated that statins stabilize vascular plaques in the process reducing your chance of stroke.
 
I have a general policy of trying to avoid all medication. Of course there have been some that I have to take now with my current illness or I wouldn’t be alive, but as a rule, I start with not wanting to take any medication. The side effects are always a consideration. Historically, in my life, if there’s a side effect that isn’t necessarily common, I’ll be one of the lucky one’s. I don’t know much about statins, but my understanding is that it’s preferred that you take CoQ10 with it. That right there makes me feel like it depletes your body of something.

As for the calcium scan, I’ll see my PCP next week and discuss the statin and the scan with him.

Like you, I tried to avoid all medication. But as I age I notice my body isn't what it used to be. And I have a family history of heart disease. I took the statins. No noticeable side effects so far.
 
After looking at my numbers and learning more about my lifestyle, my cardiologist didn't think a statin was warranted, but recommended a Calcium CT scan. Calcium score was 0. I'm on traditional Medicare. Medicare was billed $345 for the scan, Medicare approved $124 and paid 80%, supplemental paid 20%. Until learning my calcium score, my PCP had wanted me to begin taking statins.
 
The worst side effect of statins is pushing you towards insulin resistance and diabetes. Most people do not realize that they are on the insulin resistance path to diabetes and normal tests only find it too late.

Insulin resistance and diabetes are a major cause of cardiovascular disease in combination with lipoprotein particles (aka cholesterol).

Higher dose statins trying to lower cholesterol can actually make things worse. If you want to lower your lipoprotein particle count in the hope that fewer particles will get into the arteries and turn into plaque, then combination therapy with low dose statins plus ezetimibe (which blocks absorption in the intestine) or bempedoic acid (which affects only the liver and does not push diabetes) is the route preferred by up to date lipidologists like Dr.Dayspring.

But just lowering cholesterol without changing diet and lifestyle and reducing inflammation is not addressing the root causes.
 
Childlike, maybe, but I have this idea that decades in medicine, medical school, residency, ACP qualifications, continuing education, and QC by his large medical group might, just might, have resulted in his knowing more than I could learn from a little internet research, random anecdotes, and consultation with SGOTI. I don't need him to justify his opinions to me, though I do expect and get discussion of tradeoffs where I have questions or where significant tradeoffs exist.

WADR, sometimes you guys crack me up. :)
 
Interesting that no one in this thread has mentioned how statins reduce inflammation in the cardiovascular system. The body's reaction to inflammation in our arteries results in a higher risk of heart attack. When I was 48, I had my calcium score measured at zero. At 73 y.o., my calcium score is 119 measured a few months ago. I take 20 mg of atorvastatin a day along with a low dose aspirin. I get exercise and maintain an acceptable weight. I've not had any side effects that I can see from the statin. My doctor says I'm doing the right things.
 
Only take one med which is Prevastatin for high LDL. It lowered my LDL from 140 to under 100. Triglycerides went down quite a bit too. Plus my HDL to Triglycerides ratio is under 2.0
I had to switch 3 times to find the statin which didn't give me cramping.
 
There are studies that suggest if you lower your cholesterol below 70, you can begin to actually reduce the size of blockages in your arteries.
 
Check out the 6% rule for statins.

The first lowest recommended dose gives the biggest decrease in cholesterol. After that each doubling of the dose knock another six percentage points off the cholesterol count.
  • if the dose of a statin is doubled then there is an approximate 6% increase in LDL lowering efficacy by doubling the dose - the so-called 6 percent rule
    • for example
      • rosuvastatin statin 5mg produces an approximate LDL reduction of 40% - if the dose of rosuvastin is doubled to 10mg then there is an approximate 46% LDL reduction expected with this dose of rosuvastatin
      • pravastatin 20mg produces an approximate LDL reduction of 24% - if the dose of pravastatin is doubled to 40mg then there is an approximate 30% LDL reduction expected with this dose of pravastatin
    • the "6 percent rule" holds approximately for all statins (1,2)
 
Childlike, maybe, but I have this idea that decades in medicine, medical school, residency, ACP qualifications, continuing education, and QC by his large medical group might, just might, have resulted in his knowing more than I could learn from a little internet research, random anecdotes, and consultation with SGOTI. I don't need him to justify his opinions to me, though I do expect and get discussion of tradeoffs where I have questions or where significant tradeoffs exist.

WADR, sometimes you guys crack me up. :)
That would be fine if science (medicine) was a settled concept. We learn more and more every day and to think a doctor can keep up with all of it with the patient loads they have today is not realistic. Further, to think that the medical profession (doctors and heath system administrators) are not significantly influenced by the pharmaceutical industry would be naive. I don’t think I know more than them, but I do consider myself an equal (maybe more) partner in my healthcare and I do question pretty much everything that enters my body. I also look for what lifestyle changes I can make rather than taking a medication. You can’t blame doctors for favoring medication given the average American lifestyle and eating habits but about 15 years ago, I started doing my best to do better.
 
You can’t blame doctors for favoring medication given the average American lifestyle and eating habits but about 15 years ago, I started doing my best to do better.
So, don't take a statin. We all make personal decisions regarding what path we wish to follow regarding proposed medical treatments and you've made yours. You don't need consensual validation for this kind of personal decision.
 
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