Intermittent Claudication and Statin dosage

[Somerford]

This forum has been extremely helpful to me in receiving advice on my condition.

I am hoping some of you good folks can help me again. I am 80 years old and was diagnosed with PAD almost two years ago. In the past I was a competitive club cyclist. A sport I love. I am lucky and I continue to cycle with my friends albeit with an e-bike doing roughly 50-60 miles per week. Now for your help.

I opted out of surgical intervention having weighed up the risks and after discussions with my VS Surgeon and family. Surgery does remain open for me.

I have undergone my annual review with my VS Nurse and MOT by my GP.

My cholesterol is sitting at 5.4% with my LDL at 3.86. Slightly down from my last reading of 5.8%. My VS nurse says that ideally your LDL should be 3.

My AB Index on my right leg is -76 down from -81 twelve months ago,. My left leg is over 1 which is fine. The deterioration I expect will continue. Not sure what happens after that??

Both my GP and VS nurse have recommended that I should increase my daily dose of Atorvastatin from 40 mg to 80mg to stave off the risk of a stroke. I am told the side effects can be pretty bad with severe muscular pain. Apparently in the upper body and arms. My nurse says it can be severe.

With in mind my love of my sport I am deeply concerned that this could be my death knell, if I am forced to give up the sport I have loved during my life time.

My son has spoken to a friend who is a GP. He said ideally that I should increase the dosage as well as continuing to cycle if I can. If I cant he said tell your father to go back to the 40mg and continue with his sport since this exercise is still good for his condition.

An alternative would be to opt for 60mg and see how it goes.

I know many sufferers of this condition will have gone through what I am facing and I am anxious to know of the worst side effects of increasing your daily dosage of Statins by such an amount. Is it so debilitating?

My apologies for the length of my posting but I am hoping that out there, there may well be someone who has faced a similar choice.

Thank you.

[MichaelJH Heart Star]

Hello again...

PAD (Peripheral Arterial Disease) from which many of us suffer is a terrible disease which can really impact on your quality of life. The fact that your cholesterol is not ideal and your ABPI (Ankle Brachial Pressure Index) has reduced further suggests to me you should try increasing your Atorvastatin. I had bad shoulder pain with Simvastatin but not with a higher equivalent dose of Atorvastatin. I am not on 80mg as it stresses my liver tlo much rather than any muscle aches. So I would say try the 80 mg and reduce to 60 and then back to 40 if you get any muscle pain or a skewed LFT (liver function test). The LFT should be carried out about six weeks after you increase the dose. If you do get issues it may be appropriate to take a short break off Atorvastatin but your GP should advise rather than me. My vascular surgeon also favours a mini Aspirin (75 mg). Good luck.

[Grey24]

My weekly cycling activity is similar to yours and I have been taking 80mg Atorvastatin for 2 years, with no problems at all. I have not experienced any side effects. Why not try the higher dose and see how you get on with it?

[Mart25]

I don't have PAD so cannot comment on this aspect of your post. But I am on statins and I have done quite a bit of reading about cholesterol. I predict you will get a range of responses to your post - some people will have suffered side effects which they attribute (rightly or wrongly) to statins, some people (probably the majority) will be on the highest dose and have noticed nothing. There is really no alternative but to try 80mg and see what happens. Side effects seem to be reversible, so you can always drop back to 40mg later.

What is less well known is that doubling the dose of atorvastatin from 20mg to 40mg, and 40mg to 80mg only reduces your LDL cholesterol by about 6% for each time you double the dose. So if you go from 40mg to 80mg you can expect about a 6% reduction in LDL cholesterol. In your case, your 3.85 would go to closer to 3 but probably not below it. So I strongly recommend you get another cholesterol test done after a couple of months at 80mg to see what's changed. You and your GP may feel that the benefits are small compared with the side effects.

Finally, and also less well known, is a medication called ezetimibe. It reduces cholesterol by a completely different mechanism and it works well in combination with a lower dose of statin. This may be something to think about later after you have tried a higher statin dose. Ezetimibe too has some other potential side effects - so nothing is straighforward! But I'm taking 40mg atorvastatin plus 10mg ezetimibe and it does the job for me.

Hope this helps.

[PeterpPiper]

I take 80mg of atorvastatin with no side effects . It’s also good for your teeth you know

[Dj1962]

Hi..like you I'm a cyclists and on 80mg statin, I've had no problem with this drug, as for the others they put me on, its been challenging and really affected my sporting activities..

[Clairealou]

I’ve been on 80mg of Atorvastatin for years with no issues aside from a little aching in my legs at night which could also be the PAD. Sim astatine did cause me liver problems but Atorvastatin has been fine.