GP and Cardiologist Disagree On Statins

7 months post Covid and unfortunately I'm still having issues. Went to the cardiologist to check my heart just in case. Normal echo, initially a normal EKG, but my stress test showed an inverted T wave. After bloods tests, he wanted me on statins and BP meds (BP is -140ish/90 and LDL of 159. Normal HCL, triglycerides, normal blood sugar. My Calcium test scored was 1.4 which is not 0 but it's barely over the threshold into the minimal category. I'm 37, no family history of heart attack, just high blood pressure and type two diabetes (1 grandparent). My GP thinks that I just need to make live style changes, by my cardiologist is pushing the statins. Thought?

Cheers.

[Milkfairy Heart Star]

Hello dabbmw2002

Welcome to the forum.

Statins don't just reduce cholesterol levels they have an important role in reducing inflammation and stabilising even small areas of plaque.

There have been a few studies to suggest that patients with Covid who are treated with statins have a better outcome.

medscape.com/answers/250011...

Has your Cardiologist also suggested you take an Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) ?

Again this maybe to treat the effects Covid is having on your heart.

I suggest you contact your Cardiologist and ask them to explain the reasons why they recommend your particular medication to both you and your GP.

I hope your heart improves and you recover fully from Covid.

[Hidden]

Unless you have reason to believe that they’re incredibly incompetent and shouldn’t be practicing medicine, I would always take the advice of a consultant over that of a GP. The reason for that is simple: GPs are quite literally the Jacks of all trades, masters of none. They have extremely broad knowledge of many things, but with a few exceptions, no real expertise in any particular area, which is why they (should) refer you on for expert opinion when required. I’ve got a condition my current GP had never even heard of before I turned up, and have been misdiagnosed and/or had diagnoses completely missed several times purely as a result of GPs not having sufficient knowledge and understanding to join the dots, and it’s only when I’ve finally made it to a consultant (sometimes several years after a problem started) that things have been sorted out. For me personally, I would take the view that you have a consultant that only ever deals with hearts recommending a treatment, and they’re not going to do that unless they believe it’s necessary and in your best interests, so I’d go with that.

[Hidden in reply to Hidden]

Yeah, I get that. My cardiologist seems very disinterested and doesn't seem to listen to what I'm telling him. Once I got my stress under control my BP started coming down and I have a huge change I can make in lifestyle. At my age I feel a change can be made before a lifetime commitment to drugs. That's the reply im going give it some more thought.

[Hidden in reply to Hidden]

I can understand that, partly because I’m the same age as you, albeit in a very different boat.

I wonder if perhaps understanding the cardiologist’s reasoning would help you make the right decision for you: they will (should!) have a justification for suggesting medication over lifestyle changes, and it may be helpful to everyone if you know what that reasoning is before deciding which option is most appropriate at this point. It may well be possible to sort things out with lifestyle changes, but my own experience is that cardiologists are also reluctant to prescribe unless they really think it’s necessary. You can always phone the cardiologist’s secretary and ask to arrange a brief chat just to understand why he thinks you need the medication, or failing that even ask him to write to the GP explaining the reasoning and copy you in. Treatment decisions should be collaborative and ultimately take the patient’s wishes into account, but to make an informed decision, you do need to have all the facts to start with.

[fergusthegreat]

Take the statins, you have atherosclerosis and are only 37.

[MichaelJH Heart Star]

Hello and welcome to the forum!

Your LDL is right on the borderline high. Lifestyle changes can have an effect but much depends on the starting point. If your BMI is 30, you exerise is the remote control, you eat McD's and KFC's regularly, etc. there is plenty of room for change. But if you are in the normal BMI range, eat healthily and exercise regularly there is little room for change. I would suggest you start a statin for both cholesterol reduction and the other effects @Milkfairy mentioned. If lifestyle changes have an effect the statin dose could be reduced to a maintenance dose.

[Hidden]

I found myself in a very similar situation, except both GP & cardiologist wanted/want me on a Statin, I read up quite extensively on the pros & cons and all the conflicting info from within the medical profession, I decided to try them.

I reacted quite badly, within a few months I could hardly walk or move my arms/shoulders! I stopped taking them and thankfully everything got back to normal.

They now want me to try a different one, just every other day....... the jury is currently out.

Depending on your current lifestyle it may or may not be so easy to address it without them, just be aware of the known possible side effects.

[Milkfairy Heart Star in reply to Hidden]

However the situation maybe different if someone has heart problems due to Covid?

There is non obstructive coronary artery disease as well as obstructive coronary disease.

[Hidden in reply to Hidden]

That's my concern. Amlodopine made my feet swell and gave me heart palps at night and did little for my BP. My old had similar issues and he just got his lifestyle and quit taking everything. He's in his 60s and doing just fine.

[Hidden in reply to Hidden]

Unless the cardiologist can give a really, really good reason as to why drugs over lifestyle AND as long as you have the capacity to make the changes necessary to make an impact, then at 37 there is no way I would be taking a statin.

If you don't take them and you fail in the lifestyle changes, you can always re-assess your decision.

[Milkfairy Heart Star in reply to Hidden]

Can I ask did you develop heart problems due to your Covid infection?

If so this maybe something to consider when making the decision whether you wish to follow the advice offered by the Cardiologist you consulted.

[Hidden in reply to Milkfairy]

Thats the thing. My cholesterol and BP were borderline before Covid, but I was physically active without issues. Even after my Covid infection, follow ups with my doctor showed a normal EKG and my BP was 128/88. Elevated but not extreme. It was only after months of stress and anxiety from not recovering fully that my BP went up. My anxiety was out of control and I think that was the cause of my BP being read at 150/100 which is what the cardiologist saw. Today, with my anxiety back under control and without meds my BP is back down to 130-140/90.

But yeah, my current discomfort is directly Covid related. I've had extreme fatigue, exercise intolerance and other nagging issues like tinnitus, tremors and dry eye syndrome. So, my nervous system is out of wack. That being the case, I don't think my occasional chest discomfort and SOB is from a preexisting heart condition, but from whatever disregulation Covid did to my system plus lots of anxiety. Problem is, since Covid is a novel virus the doctors don't really know whats going on.

[Milkfairy Heart Star in reply to Hidden]

I am sorry to hear this.It must be so frustrating for you.

Uncertainty and not knowing can create anxiety for both patient and doctor alike.

I know I live with a rare, poorly understood and recognised type of angina.

Have you asked to be referred to a long Covid clinic?

There is growing evidence that Covid effects many organs in the body including in particular the inner lining of the blood vessels the endothelium which helps regulate blood pressure, blood clotting and stops the blood vessels constricting in spasms.

The BHF has some information about how Covid may effect your heart and blood vessels.

I hope it helps.

bhf.org.uk/informationsuppo...

[Hidden in reply to Milkfairy]

Thanks. I'll take a look.