I am being prescribed Atorvastatin along with other drugsl pending further tests after an acute cardiac event. It is acknowledged that it is unlikely that I have a heart problem (I've already had an angiogram and that showed I have very healthy arteries). My question is when taking this drug merely as a precaution can there be any harm caused?
Atorvastatin Concerns - No Cholestero... - British Heart Fou...
Atorvastatin Concerns - No Cholesterol Problems
Do you really think a medically trained person would prescribe a drug that would be harmful? Statins get really bad press but are commonly prescribed to many with or without heart problems. Yes they are used to reduce cholesterol as well as other symptoms. Ask your practitioner the reason for putting you on a statin Take care
Thanks for your reply. My main concern is that I do not want to be taking drugs that I do not need. Tests so far have shown zero pathology with my heart and cardiovascular system. I of course appreciate that doctors abide by the hippocratic oath but I also believe that a person knows their own body and a general approach does not always meet the needs of all individuals. We are unique after all, our bodies react differently and yes I believe that doctors can be blinded sometimes by principles and pathways. I am a psychotherapist by the way and so am very aware of these processes. So, I ask questions to ensure my personal wellbeing. However, I do not make accusations. My question was not to accuse doctors of causing me harm, but whether this drug could inadvertently cause harm in a variety of circumstances and to seek the experience of others who perhaps are in similar circumstances to me (i.e. taking the drug asymptomatically).
Ok so good luck and my advise is a little knowledge can be a dangerous thing Just an old saying that springs to mind
Absolutely Gilread1. I couldn't agree more. However, more knowledge and detailed knowledge in my view are absolutely good things. I also feel that blind trust can be a dangerous things. We are all different however and take a different approach to healthcare. I am not criticising the drugs or the practitioners but merely seeking to optimise my own health in the absence of any detected pathology so far.
You need to advocate for yourself and unless you can have a conversation with a doctor about absolute risk/ reward benefits the conversation is limited to you must take it. Here is a little scene that I lived. I was prescribed daily aspirin for risk reduction benefit in 2018, but, I reacted very badly to aspirin and stopped taking it. In consultation with the cardiologist , while in hospital, it was agreed to stop aspirin and switch to clopidogrel for life. What I did is what I always do , I researched the new medication; which included thoroughly reading the info. sheet you get with the medication. I learned that there is an inherited liver enzyme that has a strong influence on your bodies ability to activate the drug and a blood test can be done to establish your ability to metabolize. I brought this up to my doctor and asked for the blood test to make sure I have the ability to metabolize the drug and in turn have confidence in the the drug doing it's job. He had no idea what I was talking about said no one every asked about it. Luckily for me he made some calls and found out yes indeed they can do a blood test. Turns out I am a moderate metabolizer, you receive one gene from each parent. So, as a result of my informing myself I learned that I was not receiving optimal benefit from this drug, I was advised by the specialist to either take it with aspirin or take aspirin instead and if I ever need an anti platelet in future take ticagrelor. In my opinion if a cardiologist is prescribing something for life he should at the very least have mentioned this possibility. So they know some people will get no benefit but don't run a simple blood test to assure themselves the patient is going to respond. In doing my research I also easily discovered that there was a huge law suit in Hawaii over this drug . The suit was won by the victims , as it was demonstrated the pharmaceuticals and medical powers that be knew that many people have no metabolizing ability at all, and neglected to establish protocol to test before prescribing. I live in Canada and I learned they are pushing hard to have this blood test done on every person prescribed this drug. So in summary my doctor had no idea of the blood test for potential efficacy; it was not mentioned while in hospital as two cardiologists stood over me and being told it's vital to take it every day for life (risk management). I can only believe that check box medication protocol can prove detrimental, one size does not fit all. so I agree information is power, and it can be a blessing or a curse depending on your personal point of view. So yes, drugs are given to lower your potential risk of developing a problem you may or may not currently have or ever develop, if they are beneficial for you is a different conversation ,as is the potential harm to you as an individual. This is my experience, it's stressful but worth the effort for me because all medications have known negative consequences and it's up to me, not my doctor, to decide if risk reduction outweighs the potential harm .
Well done for your research and ensuring the care you receive is the best for you. I would just make one point which is that (having lived in North America for a time) the healthcare systems are very different. It seems to me that there is more partnership and more involvement in healthcare possible in North America whereas in the UK it is very much more autocratic and a greater fight is needed to influence care received. This is not a criticism but just a recognition of the different systems and perhaps the implications of different fundings and different cultures.
I work in an equal respectful partnership with my Cardiologist. He respects my expertise by lived experience, I respect his expertise by training.
We co wrote my admission and care pathway together.
It is your choice to decide to take up the offer of any care that your Cardiologist suggests.
However perhaps keep an open mind about the cause of your cardiac event?
Talk to your Cardiologist, maybe adopt the BRAIN system to help you make a shared decision with your Cardiologist.
B- Benefit of the intervention.
R - Risks involved
I - Intuition what do you feel about the care offered
A- Alternative are there any,?
N- Nothing, what if I do nothing what happens?
At last someone who, like me, does not blindly accept everything in life at face value especially when it comes to your own health.
Thank you for sharing your experiences. I think my hubby is a poor metaboliser. As his heart drugs don't seem to be working well. Can you tell me the exact name of the test please, so we can get one ordered.
Blind trust is indeed a dangerous thing, especially with politics and religion having an affect on some medical practitioners choices / suggestions. (It shouldn't happen but does more frequently of late). After an acute MI, combined with cardiogenic shock, I too decided that responsibility for my health and ongoing treatment, should be researched in depth by me, and debated and corroborated with my GP and or Cardiologist. They have, so far been most grateful for this personal intervention.
Exactly. Too often the script is followed without diagnosing the consequences for the individual. I suppose it is due to resource constraints, so one card for all in general. It seems to be standard practice to give statins, and I do know people personally that had very bad reactions (proven). Then again millions take them without issue including myself. I too never had above normal cholesteral but still have atherosclerosis and occluded rca. So you do right to be cautious. You have to be careful you do not feel symptoms after taking a drug just because you think it will happen.
Initialy I was on rampiril but gave me a terrible lung issue and switched to losarten without issue. I currently have beta blockers problems. You do have to be very careful what is prescribed.
Thanks - this is what I am trying to navigate at the moment. It is a difficult balancing act I realize
Actually a medically trained professional ie a consultant,prescribed some tablets for my husband and 4 of the things on the patient information leaflet,that said don’t take it,my husband suffered with!! On the advice of the pharmacy he took three of the tablets and the next couple of days he could hardly walk due to tendinitis brought on by the tablets.He rang another consultant and he said stop taking them straight away!! So yes medically trained professionals do get it wrong sometimes.
I worked for nhs for most of my life and I’m afraid drs do prescribe medication that cause harm as well as good because it is impossible for a dr to know all the side effects of a drug and statins can cause for one severe muscle pain so I think it’s up to us to investigate the good and bad side effects of any drug given
Have you been prescribed a statin to lower elevated lipid levels? Statins are usually prescribed for this, and the benefits are long term rather than short to medium term. I have been taking statins for well over 20 years since my early 50s to lower my cholesterol levels from nearly 10 to something significantly less. Even so after an NSTEMI four years ago I was told I have some coronary heart disease. However without taking statins over the years I likely would not be here, so for me, as for the other meds. I take, the benefits far outweigh the risks.
I have been prescribed a statin but not for elevated lipid levels as I don't have elevated levels but this is part of the current 'just in case' regime prescribe. It is great that the medications are here and it sounds in your case that they have been life-saving. It is also great that we have well-trained and experienced doctors to help us. My current frustration though is that there are no indications (so far) of anything abnormal happening in my heart of cardiovascular system but of course I am going through all the checks and appreciate the doctors doing what they can to limit risks. Nevertheless, as things stand my questions are about whether I have any risks.
Yes, you do have risks. We all do, even children these days. You are being investigated for an event that you experienced and that alone will qualify you for risk management. For you at the moment it's primary prevention, if they find an issue it will be secondary prevention. Either way they will prescribe the standard medications to reduce future risk of an event, mitigation strategies if you like. So your current state of health is not the issue, it's the future potential (risk) for heart disease that they are treating with medication. You must decide if you agree with their risk analysis based on your body, genetics and life style etc. . I personally would go through life style risk reduction measures as a starting point, then see how you respond. You are in difficult situation since all the traditional risk markers they use to predict a persons risk are all showing you are low risk. Why "fix" what ain't broke, or medicate healthy arteries are good questions; the answer will be "it will reduce your risk".
Thank you Jack2019 - a really lovely answer. I have been feeling very frustrated since coming home from hospital last Thursday. Of course the hospital experience is part of the recovery too but I have been experiencing side effects from the medications and what has happened has also been a big shock. Some adjustment time and alternative perspectives have been needed and this forum is great for that so thank you.
Whilst most articles say the aim of statins is to reduce cholesterol they specifically target LDL (bad) cholesterol. Do you know your total cholesterol and LDL cholesterol?
No I don’t but I have never had cholesterol problems before and my understanding is that I have been prescribed this statin as part of a ACS response strategy. A high dose though as I understand it.
What dose 10mg, 20mg, 40mg or 80mg?
LiziJ,
It's likely your cholesterol numbers were recorded when you were in hospital, so it might be worth asking your GP.
Re the statin, as MichaelJH says, a liver function test (LFT) should be carried out four to six weeks after starting the drug. Your GP should arrange this, but given current circumstances, you may have to ask!
I will ask my GP thank you about cholesterol numbers and LFT. This is all new to me. Can the statins damage the liver then?
OK thanks. I will speak to my GP
I have been looking at the BNF entry for atorvastatin. While it says the dose of 80mg is advised for secondary prevention it also states that it is unlicensed for secondary prevention. Does anybody know anything about this?
You mention an acute cardiac event, clearly not a heart event with healthy arteries I suspect? These drugs appear to be short term "pending further investigations".... So in answer to your question, no harm will be caused in the short term, just make sure you keep the pressure on track so the investigations are completed ASAP in order that a proper assessment and treatment is delivered. Hope you are recovering well.
I am calling it an Acute cardiac event because as yet there is no evidence of heart attack, the definition of which is some kind of blocking of the arteries as I understand it. The Cath lab consultant told me after the angiogram that my arteries are in pristine condition. The hospital however are saying I had a heart attack and clearly there was stress on my heart as I had elevated Troponin levels although only moderately elevated. I have read that it is possible to have a temporary blockage which resolves itself so maybe I had that when in shock from the trauma of being stuck in a manure bog and needing rescuing by the emergency services and suffering hypothermia. Thanks for your advice and reassurance. I will keep the pressure on to get the remaining tests done ASAP.
I have to ask, 1, what were you doing in a manure bog, 2 do your patients ask as many combative questions of you as you seem to ask of your medical professionals, Statins, far from being the "take a pill it will get better" are a very good way to reduce cholesterol levels in people who are otherwise unable to by natural means, overweight, socio economic reasons etc. the important thing about every medication is to understand the side effects they may cause, then weigh up the benefits vs the effects and decide whether to continue their use. Good GP's will do this, if not, ask!
and remember not everyone will react in the same way to each and every drug, if you read the possible side effects leaflet on every medication chances are you wouldnt take it!!
Hope you are feeling better
That is right and I do prefer not to take medications but to focus on natural means to manage health but of course this is not always possible. As for the manure bog it looked like a pile of earth that I planned to climb over to take a short cut to avoid a deep puddle, about 5 feet tall, but when I stepped onto it, it collapsed and held me in a vice-like grip. As for my clients, yes I definitely invite questioning, as much as is needed to feel reassured. It is not about criticising doctors but more about gaining greater understanding.
Atorvastatin is a cholesterol control drug
Aside from calling your heart problem and "acute cardiac event," did they give you an explanation of what they thought occurred?
They called it a heart attack. I am calling it an acute cardiac event. They do acknowledge that it might have been a shock and trauma response that resolved itself but are being cautious because of the elevated Troponin, albeit moderately elevated. I call it an acute cardiac event because as yet there is no evidence of damage to the heart.
sorry "an" not "and"
Troponium can be elevated by strenuous exercise - many endurance athletes have elevated levels after hard training or a race. If you were struggling++ to get out of the bog, and the exercised was prolonged and hard, it is possible that this occurred. I have had elevated troponium after hard training with good arteries - it settles
Yes it has already settled. I had a blood test on Saturday, six days after the event and it had already returned to normal. My exercise had been leisurely just walking and only 30 minutes into my walk but I was struggling and working hard to get out of the bog so your explanation works and is something like what I have been thinking and this is why I am concerned about taking all of these medications.
I imagine it is precautionary as the cause of the troponium is not clear.Ask when you can start exercising again then go out and get you confidence back with some good long and gradually harder walks
Another risk to be aware of is that of statins triggering type 2 diabetes in older women; I was prescribed Atorvastatin "just in case" to lower cholesterol after AVR surgery. Within 6 months, blood tests showed I was prediabetic. Very fortunately, the GP who called to discuss test results was aware of this side effect - it's not uncommon among post-menopausal women. But not widely known. He recommended immediate cessation of the statin and my bloods now show the prediabetic state has resolved itself. I've since mentioned this to other post-menopausal women and a couple have remarked they are indeed on statins "just in case" and are also being treated for prediabetes. Swings and roundabouts.
There was research done that showed typically those at risk of Type II diabetes developed it 6 - 7 months earlier if they were put on statins. However not taking them posed a greater risk to health because of the increased chance of a cardiac event.
The majority in the "at risk of Type II" can significantly reduce the risk by weight loss, a healthy diet and exercise. This far outweighs the minimal risk from taking a statin.
When I joined this forum I had been told I was at risk of diabetes because I was overweight with elevated BP, cholesterol and HbA1c. I followed the advice given and am now in the healthy weight range with HbA1c in the normal range. My ACE inhibitor was reduced a I lost weight as I became hypitensive. I would suggest the original poster concentrate s on weight loss and lifestyle changes reviewing things when this is in place.
It's not just post menopausal women that it effects. It can affect anyone who takes Atorvastatin. From the patient information leaflet, under possible side effects: Common side effects (May affect 1 to 10 people per 100) Increases in blood sugar levels ( if you have diabetes you should continue careful monitoring of your blood sugar levels). I know from personal experience that my HbA1c reduced after coming off Atorvastatin for a while. It won't make much difference if you have low blood sugar levels or high blood sugar levels, but because the boundary between type II diabetes and normal is pretty much set at a particular level by the medical community, it will affect those who are just underneath the level for type II. They may find themselves suddenly in the diabetic level with all the additional testing that goes with that. Not to mention the additional risk of atherosclerosis and heart disease that comes from higher blood sugar levels.
Hi Liz.
I’ve just seen this article this morning. I found it really in formative. I’m on Atorvastatin too, 10mg. Reliable source, evidence based.
theconversation.com/benefit...
Good luck.
Thanks for the link GracieOS - very informative especially the explanation of relative risk and absolute risk. I've seen a similarly well-researched studies where the use of stents is similarly investigated. They're apparently no better or worse than medication/lifestyle changes.
Having looked through this thread again, my advice is to arrange to see your GP for a medication review, especially since your hospital discharge notes should now be with the surgery. You could also talk to the BHF nurse. That way you will get a professional view on the meds you take, pending a review with the hospital cardio people. Folks on here can mostly offer layman's advice usually influenced by their personal circumstances but that may not be directly applicable to you since we are all different and the full facts of your situation are not known.
Yes thanks and I do understand the issues associated with conversations on this forum. I did speak to my GP yesterday but she reiterated what the hospital doctors advised - take the meds as a preventative measure pending further tests. Personally, I feel that there is too much reliance on troponin and interpretation of its elevation as indicative of permanent heart damage, even when there is a lack of any other supporting evidence for this hypothesis. I think I will email my GP again about the atorvastatin because the dose is so high.
Well you have an alternative professional opinion based to your personal medical situation, so the choice is now entirely yours it seems. You either follow the meds regime prescribed by health professionals until your follow up, or you make your own assessment of what you believe are the risks from taking the meds between now and your follow up and then balance those risks with potential benefits and then either continue or stop taking them for the time being.
You can have a heart attack with minimally elevated troponin, though, and also not suffer permanent heart damage having had one. My mum had an nstemi primarily characterised by racing heart and mild chest pain, but critically high bp. Her troponin never went higher than 50, and they only kept her in because of her bp. Her situation was different to yours, though, in that when they decided to do an angio just in case, it turned out she had total blockage of the LAD, and was told it was a miracle she’d only had a mild nstemi and hadn’t just dropped down dead. She got a second miracle, though, in that she had no permanent damage. Her ejection fraction, both at the time and three years on, is completely normal.
That is a great result isn't it? My troponin peaked at 391, still considered low for a heart attack. I'll hope for no permanent damage too and that the cardiac event was stress-related and brief.
It may be worthwhile having a blood test to establish your Homocysteine level. A high level of Homocysteine puts you at risk of having blood clots - the scale is normally 3 -12. I was 14.5 when tested 18 months after my HA which was caused by a clot. It is usually controlled by taking Folic Acid which I get from over the counter Vitamin B Complex tablets.
As for Atorvastatin, 80mg is the "go to" dose post heart event regardless of whether you have a high cholesterol level or not. My "base level" is 4.4. I reacted quite severely to Atorvastatin, Pravastatin and Simvastatin. Eventually I tried Rosuvastatin which I have had no problems with. After a couple of months of taking 10mg on alternate days, my cholesterol level went down to 3.6, mainly due to the lowering of bad cholesterol. I have read that a level below 3.0 could be beneficial.
Being pro-active with regards to your medication is essential. I have found most clinicians very receptive to discussing the pros and cons.
Thank you. This is very useful information. I do take a multivitamin (as well as other supplements) so hopefully this protective for the homocysteine that you mention. The atorvastatin does rather feel like using a hammer to crack a nut but I will persevere with it for now as clearly with elevated troponin something went on with my heart even if now resolved.
While I can understand your concern about taking too many meds, it is important to remember that they are prescribed for a purpose by people who do know what they are doing, and are, or should be reviewed regularly. I was admitted to hospital last July with what turned out to be heart failure. The cardiologist carried out a number of tests and over the days I was in there sorted out a revised drugs regime.
On my discharge the letter for my GP explained my test results and prescription at that point in time. Same as each of us here, of course. But it also asked my GP to order certain tests, blood tests etc at certain intervals and to adjust meds accordingly. This is the important part you are perhaps missing.
Many of the meds can take a while for their effects and side effects to show. Since then both my GP and cardiologist have monitored my progress closely and adjusted dosages and indeed actual medicines. It has been done gradually and based upon actual evidence. Some I no longer take. Just last Friday the cardiologist asked me to take a blood test to measure BNP (unfortunately named indicator of level of heart failure degree) the result of which will be used to determine whether or not I need to increase diuretic dosage. In February, a blood test by my GP showed that one of the heart failure drugs had also had a really beneficial effect on my HbA1c levels, it had taken this long for the effect to show through, but it meant my GP could drastically reduce one of my diabetes meds. We now have to watch that to see if the improvement remains or if we need to readjust. It is a slow process of titration, erring to begin with on the side of safety then cutting back or adjusting as the evidence. The cardiologists will have chosen to prescribe that drug at that dose for reasons based upon their knowledge and experience, but it will be followed by a period of check and adjust
Thanks for sharing your experience and I am sorry to hear of your heart problems. It seems to be well managed in your case though. I totally appreciate that the doctors will have been acting in my best interests and their first consideration is to protect me agains having a heart attack. For them, that is what elevated troponin tells them - a heart attack has happened. However, in being ultra careful and setting aside an alternative hypothesis of a brief cardiac event due to trauma and stress which naturally resolved itself (my hypothesis based on test results so far) I do not want to be at risk of some of the other conditions mentioned on this forum such as type 2 diabetes, or liver and kidney problems. You are right though in that what might be missing for me is the knowledge that monitoring of the impact of this drug regime is ongoing. Nobody has said anything about that to me and I will, I think, follow up with my GP to clarify it.
Hi LiziJ, I'm happy to see your post has a lot of responses ! And they have been helpful to read. My mum was in a similar position to you. She had a heart attack in Jan, not a big one (but still scary), first ever cardiac event in her life. Doctors said her heart actually looked in great condition, one cardiologist even said she didn't understand how my mum had a heart attack! All her arteries looked good, just 2 small ones got occluded causing attack (they say blood clot). She was prescribed Atorvastatin but she thinks she was having a strange reaction to it. Her cholesterol was perfect. She told the GP she was going to stop taking it, this was back in January, and they said okay. She spoke to another senior GP who said she needed to take a blood test asap to check cholesterol (she went for it yesterday). We're waiting to see... I don't really understand what could be the benefit for her if statins are 1) to lower cholesterol and 2) plaque stabiliser, but her arteries don't look fatty... guess we'll know more when we get the blood test back. Statin seems to be causing her more harm than good as her reaction to it is quite severe.
Thank you Vanbob and your mother's situation does seem very similar to mine. I hope that her blood result gives some clarity for her and you and your family.
Thanks, and I'll add I'm doing medical PhD so I like to be well informed too! Just seems unnecessary for her given the readouts!
I suggest you research endothelial dysfunction.
Also you you might find this article of interest.
Hello LiziJ,
I’m a little bit like you. I’m a retired scientist and ‘do like to understand the science’ and don’t like using medication unless really needed. I’ve described what happened to me in the hope it will help a bit.
In Jan 2021 I experienced uncomfortable feelings in the chest when walking quickly which went away on rest. Four months later it hadn’t resolved so after reporting it to the GP, who diagnosed angina, I was referred to a cardiologist who prescribed statins and beta blockers to protect the heart whilst the investigations went on.
At that time I took the statins but not the beta blockers as I didn’t want to take them if the weren’t needed.
I had a coronary angiogram which showed all the coronary arteries were fine. An ECG was also fine. However, a CT angiogram and an echocardiogram confirmed I had severe aortic stenosis and needed an urgent aortic valve replacement. On having the diagnosis I commenced the beta blockers.
My valve was replaced at Papworth Hospital in January this year. It was very badly diseased and had little utility left in it, so I am a very fortunate man to have been given more time by the wonderful surgical and recovery team at the hospital.
I am now prescribed medication for life - low dose aspirin, beta blocker and statin which are part of my daily routine and I experience no problems.
Looking at the balance at risk and benefit in retrospect I would have done things differently:
a) Contact the GP at the first sign of the ‘uncomfortable chest’ and not ignore the symptoms it in the hope it would resolve itself; b) Commence ‘protective prescribed medication’ immediately.
Wishing everything will go well for you.
Thank you for your response Tomatoes123. I am really sorry to hear of your heart problems though and I suppose it is because of the possibility of something yet undiscovered (although I still am leaning towards a trauma and shock response now resolved) that I am sticking with the medicines. My main concern is the atorvastatin as this potentially has side effects which could harm health but I will speak to my GP about my concerns.
Hi LiziJ - you might find it interesting to research takotsubo cardiomyopathy , this is when you body shows all signs of a heart attack, but the arteries are clear - often happens after an emotional episode which can be happy or sad. Everything is worth questioning.
Just cut out all animal products for six months and you'll be fine, cholesterol is only found in animal products
Hi LiziJ - you have been give a high dose of Atorvastatin which is likely to be a one size fits all response & I hope can be reviewed in your case. And a liver function test is essential after 6 weeks. I developed a seriously 'deranged liver' on 80 mg and am now on a lower dose of Pravastatin. My approach to meds is to titrate down to the lowest therapeutic with the ( somewhat reluctant ) agreement of my GP.
I assume your Low Density cholesterol ( bad cholesterol ) is high and you have been prescribed Atorvastatin which is the safest statin in terms of side effects. So glad your angiogram is normal and A has been prescribed to prevent any blockage of your arteries. Life style is also important.
Are you aware of non obstructive coronary artery disease?
heart.bmj.com/content/105/2...
I think what the cardiologist is querying goes by the acronym o MINOCA. Is that the same thing?
MINOCA , Myocardial infarction non obstructive coronary arteries.It's a heart attack occuring without any permanent blockages in the coronary arteries.
MINOCA is commonly caused by Microvascular dysfunction and vasospastic angina which are types of Non obstructive coronary artery disease.
Other causes Spontaneous coronary artery dissection.
These types of heart attacks and their causes are often overlooked,under recognized and under treated.
They also effect women more than men.
Have a look at your Qrisk score. You can do it yourself online. GP’s should use it to calculate your risks for cardiac events and the need for statins. Not every GP will think about using it. NICE guidance say about it. Good luck.
Thanks I will have a look
Perhaps you should be discussing these issues with your cardiologist if you are questioning their treatment? It is of course your right to discuss the appropriateness of treatment and of course to go against medical advice if you wish. I hope all continues to go well for you.