What's the research evidence around long-term use of Atorvastatin?

[NorthantsSteve]

Hi - I'm 55 and had a heart attack and stent nearly two years ago. I was immediately put onto 80Mg Atorvastatin even though my cholesterol levels weren't high and subsequently learned that gives the best outcome. I'm coming up for a 2 year review of the Atorvastatin (other meds get reviewed more frequently). I don't have any side effects and I wondered what the evidence was in terms of optimal dosage for Atorvastatin longer-term? Is it best to cut the dosage or to stick with it? Thanks.

[MichaelJH Heart Star]

Hello and welcome to the forum! Post stents or bypass they tend to prescribe a high dose of statins. If your numbers are OK they might reduce the dose. Besides reducing cholesterol it also stabilises the plaque so stopping it totally is not a good idea even if cholesterol is really low.

[wiltsgirl in reply to MichaelJH]

Hi Michael my statin was kept at 20mg after bypass as my levels had reduced from 6.7 to 3.4. This sounds like I should have been put on something higher.

[Bazza1234]

The long term prognosis for 55 year olds is not very good - it is even worse for 72 year olds like me

[tunybgur in reply to Bazza1234]

Being optimistic and having a positive view of the future has been proven to improve clinical outcomes.....just saying...

[Rob6868 in reply to Bazza1234]

Not very good for what? May I ask?? I'm 50 and had a stent procedure in may and still have constant chest pain.

I'm on 40mg of statin. ..

[NorthantsSteve in reply to Rob6868]

At the Cardio Rehab session I went to - it was made clear that the prognosis for me was really good (HA at 55 followed by stent). As tunybgur says there is good evidence that a positive outlook can be beneficial. In terms of chest pain - I guess you're talking to your Doc/Cardiologist about this - but it took me a while to settle down (2 years on no sensation). And re Statin dosage - as mentioned in this thread, guidance is 80Mg for 2 years following HA regardless of cholesterol level. But there are a number of factors that could mean that this is inappropriate. Good luck, Rob. It took me while - but I'd say I'm back to how I was now.

[Bazza1234 in reply to Rob6868]

You have to think a bit about what is meant by "long term" !!

[Speakeazi in reply to Bazza1234]

Perhaps you’ve already won the lottery. Looks like that from me at 56!

[tunybgur]

This is standard procedure after a heart attack.

Once your body has settled down to the new meds the dosage should normally be refined until your total cholesterol is comfortably below 4 mmol/l.

[Bazza1234 in reply to tunybgur]

This is the level that my Cardiologist wanted me to attain - it has taken me a couple of years to get there.

[tunybgur in reply to Bazza1234]

After my heart attack I was on 80 mg Atorvastatin, it was then reduced to 40 and the total level was about 3.7 mmol/l.

Reducing it to 20 caused it to go up to 4.3 so I am back on 40 as that seems to be the optimum for me to keep below 4 mmol/l.

One interesting fact from the Framingham heart study (look it up) was that nobody with a cholesterol level below 4 mmol/l ever had a heart attack.

Coincidence or not, it makes interesting reading.

[Bazza1234 in reply to tunybgur]

I am now on 20Mg of Crestor (Rosuvastatin) and 10Mg of Ezetemibe - this has got my levels down to where the Cardiologist wants them and I have had no side effects from the drugs. But at 72, who knows the long term prognosis In the meantime, I am training to complete my first marathon next year - IF my feet allow me to

[jobe1968 in reply to tunybgur]

Interesting I am on 80mg post MI and have reduced from total cholesterol of 7.2 to 2.8. LDL down from 5 to 1.5 so I can safely say it brings the numbers down. I am fifty and concerned re long term use at current dose. I will speak to the blood quack during my January review. I read the book about the Cholesterol debate and he affirmed my prescription was the right thing. Post MI as mentioned by others sound evidence exists for secondary event reduction. So popping the horse sized pills daily until told otherwise!

[tunybgur in reply to jobe1968]

ncbi.nlm.nih.gov/pmc/articl...

The above link is to a paper which investigates atorvastatin dosage and LDL reduction (there are several more if you search).

It tends to indicate that the biggest reduction is achieved with 20-40mg dosage, and doubling to 80mg has only a small additional effect, so in your case it might be worth looking at reducing to 40 or even 20mg.

Personally I like to minimise the dosage of any meds so I still have a little in hand for later.....your cholesterol can be too low as well as too high, your body does need cholesterol, it's in every cell.

[Jaycey]

Well done on getting that cholesterol level down. I would talk to your GP about lowering your Atorvastatin dose. They told me that 80mg is the NICE recommended dose for everyone after I had 3 stents fit. That didn't make any sense to me they were trying to prescribe the same dose that someone twice my size would take. My cardiologist agreed to start at 40mg and monitor. Regular reviews is the key on all these meds.

[IgottaStent]

Steve its good there's no side effects from the statins . There is controversy over statins and LDL levels. If you read Dr Malcom Kendricks book and blog about the Great Cholesterol con and some of the other articles by authoritative sources you will see that Cholesterol isn't such a bog problem, its the inflammation in the arteries.

I came off all statins, they didn't agree with me at all. Exercise, Positive Outlook, better diet are all better determinants of longevity that dose of statins

[Hidden in reply to IgottaStent]

To anyone reading this - don't come off your statins without consulting your doctor. I volunteer with rehab and most of the repeat bypasses I see are patients who stop taking their statins and still eat pizza!

[Hidden in reply to Hidden]

Yes, I’m a retired nurse and saw many repeat offenders, often with a cig hanging out of their mouth😢

[Marwaysha]

Hi I've been on Atorvastatin 80mg for 12years now I used to get regular fasting blood tests but since moving 2 years ago I've been told they don't do fasting tests any more and I've only had 1blood test done since.

[Stu888]

You’re best chatting with your GP or Cardiologist regards dosage. For me I experienced fatigue on 80mg Atorvastatin (although I also have anxiety following a MI in my mid 40s which can also cause fatigue) My Cardiologist advised my GP that my dosage could be reduced as my cholesterol was only 2.8. So I am now on 40mg and energy levels have improved. Apparently statins have a positive side effect of stabilising plaques and being anti inflammatory which some people believe may be the reason they prevent heart attacks rather than reduced LDL being the biggest factor.

[Hidden]

I have taken Atorvastatin for 3 months now for my rising cholesterol. In spite of my healthier eating habits and wt loss, my cholesterol continues to rise. I didn’t want to take a statin Drug because all I’ve heard is negative and I’m a retired RN, so docs have to do a lot of convincing to get me to get on board. I also have( had) bad knee arthritis. About a month after starting Atorvastatin, my knee pain is practically gone. All 3 of my docs say there is no connection. I googled Atorvastatin and there are plenty of reputable studies and articles on the anti inflammatory effects of statin drugs, so I believe there is a connection. Statins reduce inflammation of your blood vessel walls etc and do all sorts of good things besides lower cholesterol. They do come with side effects, luckily I’ve not had any yet. So, my knee is a supporter of statin use, lol.

Im curious if anyone here has noticed less arthritis pain since taking a statin Drug?

[jamin100]

I’m 35 and had a single stent due to a 99% blockage in my LAD last year at 34.

The week before my stent and statins my cholesterol was 3.6 (under the recommended level of 4) and since taking statins it’s down around 1.8.

Ive been on 80mg atorvastatin since the op nearly 12 months ago and obviously at 35 I have there are many many more years left.

But are there long term issues with taking statins?

I have no side effects that I can think of and will be speaking to my doctor at my next review. Just wondering if anyone thinks my cholesterol is too low

[IgottaStent in reply to jamin100]

Read Dr Malcom Kendricks Blog and book the great cholesterol con. Also there is a good audiobook Iistened to whilst jogging called The Great Cholesterol Myth. All written by Doctors and examining the evidence . It gives a balanced view of cholesterol.

[Stu888 in reply to jamin100]

I take 40mg Atorvastatin and worry about the long term effects too (reduced from80mg last year) You’re probably best discussing any worries with your GP. I adjusted my diet as well as taking the statin to include cold pressed EV olive oil on my veggies with all evening meals and have reduced my carbohydrate intake.

Apparently the Mediterranean diet helps reduce cholesterol and prevent heart disease.

[NorthantsSteve]

Thanks to everyone for your comments and for information and references. I've followed them all up. Doc has reduced Atorvastatin to 40Mg (Cholesterol at 2.9 mmol and non HDL at 1.5 mmol - so some room for increase). Blood sugar is raised so hoping that diet tweaks and reduction in Atorvastatin will help out there with a review in 3 months. Thanks again. Your comments really helped.

[CPL593H in reply to NorthantsSteve]

Did this drop to 40mg statin work out fir you?

[NorthantsSteve in reply to CPL593H]

Hi. Yes it did. In fact my cholesterol dropped further to 2.8 mmol/l. HDL at 1.5. So after 2 years on 80Mg the drop has worked well.