Hello. New to this so I'll try to be concise. I'm 76 years old. I had a heart attack (nstemi) 5 months ago. Had a stent fitted. Medication I'm taking is Aspirin 75mg, Ramipril 1.25, Lansoprazole 30 mg, Ticagrelor 90mg twice a day and Atorvostatin 80 mg. I was taking Biroprolol but was taken off it due to awful breathlessness. Was in hospital for 3 days and on discharge had my bloods etc taken. Cholesterol was overall 3.5 - I wasn't on statins. I have a couple of questions I'd love some feedback on - neither I nor my GP can get my consultant to reply to emails. Is that dose of statins normal given a cholesterol level of 3.5? I'm still breathless often, though not as severe as before the stopping of the beta blocker. BHF seem to think it's most likely the Ticagrelor. I don't think I can mess with that but I thought I might try reducing my statin dose as I believe statins can cause fatigue and breathlessness.- can you cut Atorvostatin in half? Or maybe take it every other day - or every 3 days? Or is it just a really bad idea. to reduce the dose? I feel I need to take some kind of agency as I'm getting nothing from the hospital. I had an ultrasound echo 6 weeks ago and haven't been told the result. I had bloods taken recently and everything was within norms. One last thought. Does anybody take Ticagrelor once a day?
Overmedicated? : Hello. New to this so... - British Heart Fou...
Overmedicated?
my personal view is that no tweaks should be carried out to any prescribed medication without consulting a professional - so perhaps the pharmacist attached to your doctor’s group of surgeries might help? Contact them through your doc’s receptionist . They can then we hope advise your doctor.
Many thanks Happyrosie. I take your point absolutely. My doctor won't do anything unfortunately without the consultants advice. I guess I'll have to hang in there til next March and hope the Ticagrelor stopping will improve life. I really appreciate you replying. It's pretty isolating at the moment.
Yes early days for you, need 12 months for body to settle down, take it easy , I was the same as you ten years ago , and I found the first year hard, my consultant after 12 months discontinued or reduced my meds . So be guided by your cardiologist.
Thank you for taking the trouble to reply. Very much appreciated. I'm trying to push again to get to have a conversation with him but it's going nowhere yet.
Hi, has HA in April , no need for stents but one artery to keep an eye on (LAD). I was released with 80mg of Atorvastatin and on release my total cholesterol was 5.3. I suffered with leg muscle cramps so after about a month switched to Rosuvastatin and only 5mg. Had cholesterol checked last week and now 2.8 so a great improvement, also I've cut out butter and eating less red meat and processed foods so lost a stone too. Also I switched blood thinner from Ticagrelor to Clopidogrel to see if breathing improved but can't say I've noticed much difference but it can be dropped after a year but aspirin is for life..I've been in 10mg Ramipril and 10mg Amlodopine for 20 years with no issues. Finally I have today started to reduce bisoprolol from 2.5mg to 1.25mg as feeling so tired and beta blockers can be the cause of fatigue, ideally I will get off them completely if consultant happy. Lots of trial and error but I want to be on as few meds as possible and at the lowest safe dose. Good luck.
Thanks RF260. Like you, the fewer meds the better is the goal. I just need the day to be better. It seems I have to keep leaning on the GP's door even thought they're doing their job and writing good letters....I get the impression everybody worries about risk management. Feel pretty stuck right now.
Also just noticed your point about Ticagrelor, yes was twice a day but Clopidogrel is once a day. Also if your cholesterol was 3.5 with no statin to be on 80mg of Atorvastatin seems a lot, I know we are not allowed or qualified to advise but I would raise that query when next in touch with GP..
Many thanks. Very much appreciated.
Also, just to say I know advice isn't allowed. I was wondering about anybody in a similar positions' experience. Replies all help to move forward in more focussed way - I hope! Thanks again.
Dramacentre NICE have recently updated their guidelines for secondary prevention of CVD (i.e. for someone who already has been diagnosed with CVD) as below. For that group statins are recommended irrespective of their cholesterol 'count'. Which is the likely reason you have been prescribed 80mg Atorvastatin which is the recommended dose within the guidelines.
cks.nice.org.uk/topics/lipi...
You are, of course at liberty to decline statins if you consider them unnecessary but that will be contrary to current medical thinking. However if you suffer side effects from taking statins and prove to be statin intolerant and decline for that reason, having balanced quality of life against heart health risk, that is another matter.
Thanks very much Lowerfield. It's such a tricky balance to find and so frustrating not to have a conversation with my cardiologist to get the full picture of how my heart is in.
Phone your cardiologist secutary ask them to ask him what you should do
I think there is a standard cocktail of drugs you are prescribed once you’ve had a heart attack. GPs are very reluctant to change anything as they don’t have sufficient knowledge. After constant badgering our GP did refer my husband to a cardiologist who managed to drop the offending tablet ( in his case not a statin but Metoprolol). Though that did mean he had to double his dose of Ramipril! After a separate incident that involved A&E the doctor on duty gave my husband a lecture about not wanting to take tablets saying it was ‘our generation’. I hope you get it sorted.
I got absolutely fed up and now pay to see my Cardiologist. I hope you get it sorted.
My husband is on 13 tablets and has never had any heart problems although 15 years ago a check found 3 arteries to be 30 and 40% blocked, so they are all preventative. We would like these reviewed but he has never seen a cardiologist since. Given the current difficulty in seeing our GP (and poor service received previously) we intend to book a private appointment at our local private hospital. For £200 we can see the cardiologist who is the lead at our local hospital. We will get an hour with him and can go through every drug and get them thoroughly reviewed. I did the same thing with my own diabetes medication, with excellent results.This may not be a route you wish to take, but we have found it to be brilliant as a "one off". You still remain on the NHS list, and the consultant can make recommendations to your GP, which certainly ours followed.
Many thanks for your thoughts. I've been thinking about this route - finances not up to it at the moment unfortunately.
I refused statins and stopped taking Dapaglifozin which had raised my cholesterol. My cholesterol dropped in 30 days from 6.4 to 4.6. My cholesterol today is 3.3 as I am vegan. I’ve been surviving just fine for the past 15 years without statins. Sometimes GPs don’t always make the right decisions when it comes to prescribing statins too those who have low cholesterol. There’s a really good documentary on YouTube called statin wars which is worth watching if you’re on them and your cholesterol is low.
I'm having difficulty understanding how you lowered your Cholesterol so much without medication.I have always been aware it is 80% generated by the body and 20% by diet.
Can someone reply with more current understanding?
Hi there, I have never before nor after my stemi had high cholesterol levels but am still on the 80 mg of atorvastatin. My cardiologist wouldn’t budge on lowering it as it’s a protective measure given my body regardless of cholesterol clearly likes leaving fatty deposits in my cardiac arteries. We live in a time when GP’s whether they like it or not must manage our cardiac problems. It’s not ideal of course but it’s how it is. People on this site often talk about side effects from their cocktail of drugs and most times, right or wrong, it is their GP not cardiologist that sorts it out for them. There are alternative medications available to you that folks have mentioned here so I would suggest finding a GP that will do their job so you don’t suffer daily with side-effects. Good luck to you and hope you sort it out soon and ease the breathlessness which can’t be easy to deal with everyday.
Many thanks. Yes, my understanding was that it was my GP that could sort things out if there was a problem. It seems that there is a lot of fear around making wrong calls.
Your cardiologist is likely following the current guidelines issued by NICE which basically says that anyone who has known CVD should be prescribed statins as a secondary preventative measure. And the guidelines indicate 80mg Atorvastatin is required. And this is irrespective of your lipids profile. More here
healthunlocked.com/redirect...
Thanks so much for that. I'm quite shocked by it. I had no conversation with anyone about starting statins and no discussion about the reasons or risks. I've also had none of the follow ups. I appreciate you pointing me in this direction very much.
There is information on the NICE website including a pdf Patient Decision and information document which will be found in the link below
nice.org.uk/guidance/ng238/...
Thank you. Very alarming potential effects.
hi
I have been on this aggressive dose of Atorvastatin for 6 years since my HA. Cholesterol well controlled as a result of this plus diet. My understanding is the statin helps stabilise deposits in the arteries and reduces risk of further ha. A recent appointment with cardiologist confirms I am on the gold standard meds. They are the experts so I stick to their advice.
Yes, I think this additional effect (stabilising deposits in the arteries), not just the reduction in 'bad' cholesterol, is important to consider.
Many thanks. Yes, It seems that primary use and secondary use of statins are very different things to consider.
I’m 56 had my heart attack in January and are taking the same medication as you I did have my ramipril reduced because of feeling giddy and ticagrelor I’m taking twice a day 90mg. If I was you I would get a doctors appointment and tell her/him your concern. I did a six week exercise course to build my strength and breathing which helped my mental health and breathing.
Hello, it's 12 months since my heart attack so I have been taken off the Ticagrelor. On my discharge notes from the hospital it stated that Tigagrelor was only for 12 months. I do feel better since I stopped taking it, definitely not as breathless. As happyrosie as said, I wouldn't mess with the meds personally, I would contact the consultants secretary to see if she/he could have the conversation with the consultant & get back to you. If not, it might be worth checking your notes to see if it's for 12 months only. Let us know how you get on x
Many thanks for your reply. It is for 12 months which at least gives some light at the end of the tunnel. Contacting the secretary hasn't worked so far but I'll have another go.
I had a Stemi 4 years ago. I was prescribed the same sorts of meds you are taking. (dual antiplatelets (aspirin and in my case clopidogrel), Ramipril, and atorvastatin, but 40mg)
Earlier this year, I was seen by a cardiologist who said that although my cholesterol levels were OK for someone who has not had a heart attack, the current guidelines call for increased doses of Statins to lower my cholesterol even more. So I was put onto 80mg of atorvastatin.
Not sure if it is giving me any side effects, possibly a constant feeling that I have a cold.
Hi Dramacentre , I had Nstemi and quadruple bypass in July 2023. I was rehabbing quite well physically but encountered some issues/side effects after about 4-5 months with pains, tiredness, cognitive impairment, zombie episodes of being spaced out. I got agreement from a locum to stop 80mg artovastatin (after 6 months post surgery) and I felt fantastic. The trial period was lengthy as I couldn’t get an appointment with my GP to recently meds so it went in for about 7/8 weeks. GP tried me on 40mg pravastatin and within a week I had zombie episodes again , then I went on 10mg rosuvastatin and been ok on this. I asked GP if the artovastatin dose could be reduced initially and she said no 🤷..
I’m also on 1.25mg bisoprolol, half a 1.25mg ramipril, was on clopidogrel (now finished) pantaprazole and aspirin. My pharmacist has been great , I spoke to her when I had episodes on statin and she was pivotal in supporting a change for me , she wrote to my gp and says they’ll take notice of her. I hope you find a solution ,
Thank you. Yes, I think I've not been well served by my pharmacist and will look to change.
Just a word about my meds after triple by pass. Put on the usual ones - ticagrelor was one and bisolprol was one. The beta blocker reduced my HR to 35/40. It didn’t matter how small a dose I took. So cardiologist removed this. I didn’t feel particularly well for the first year and didn’t realise the ticagrelor was the problem. It affected my breathing. I could hardly finish a sentence without stopping. I bruised very easily. My nose bled each morning (not a lot more nuisance than anything). After the first year was up I was taken of the ticagrelor and only then did I realise that it had been the problem. Was put on Clopidogrel and never looked back. I felt like a new women for the first time after bypass. Never having any experience with heart problems everything was new to me but in hindsight I should have pursued doctors more. A word about statins - I personally can’t take any of them. My side affects are significant. Hope you get your meds sorted.
Many thanks. BHF nurse felt it's the Ticagrelor causing the problem for me. Is it always the preferred choice above clopidogrel do you know? I was told they do slightly different things.
I’m told that there is a set regimen for after stents and bypass. Of course I didn’t figure this out for about a year. I didn’t find this forum early enough. I didn’t understand that I had options with regard to medication. So my advice for newly diagnosed folks would be discuss ALL side effects with doctor. Don’t be afraid to ask questions. If there is anything that doesn’t feel just right pursue your doctor. Ask for alternatives. Good luck.
Thank you. This forum is great. I'll keep at my GP.
I queried my sack full of drugs after my stents with my consultant who got it down to 4 meds a day. I refuse to take statins. When clopidogrel was stopped after 12 months I started buying my own coated aspirin tablets so stopped the Lanzoprazole too.
All the research says that statins are crucial when you have stents and that diet alone does nothing as such to stop fatty deposits. Unless you have a very good reason not to be on statins I would get further advice on them. they have a lot of bad press online although this is mostly for people that are prescribed them with low risk of heart disease?.
hi I do agree you can speak to your pharmacist and get advice. You can also speak to PALS at the hospital to say you not getting the care you need and that a consultant review is required with your GP to aid you health needs. They will look into it for you.
Thanks to all so much for replies. It's extremely helpful, simply to be heard apart from all of your useful thoughts. Very much appreciated. I'll have another go at chasing the consultant and change pharmacists as well I think, for a more helpful, knowledgeable one.
You have my sympathy as you are stuck between a rock and a hard place if your consultant doesn't reply to emails and your GP isn't confident enough to tweak your medication. It must be very frustrating.
I did manage to get my GP to reduce my atorvastatin from 40 mg to 20 mg because my read out showed that my triglyceride level was below range. Is your GP monitoring your cholesterol levels? If so you might be able to make a case from the readings. We do need lipids but some of the medical profession has got the idea the lower the better, which is not the case. I wonder if you could propose to the GP that the atorvastatin is lowered as a trial with monitoring of the situation.
On a different tack I take CoQ10 every day which helps me cope with the tiredness effects of the statin. I understand it's pretty standard in the States to take the the two together. CoQ10 is a supplement so no prescription needed.
Thank you. I shall look into that for sure.
hi,
I had a heart attack and stent fitted 10 weeks ago and was put on the concoction of medicine you are on - I was awful on them .. so breathless , the cardiology team changed my meds to clopidegol as my body reacts so much to ticagrelor.. might be worth asking for the change and seeing how you get on?
All the best
Karen
Many thanks. I was just asking of somebody whether Ticagrelor is always the first choice. Does it do something different from clopidogrel do you know?
Don't know but am interested to find out too
They both do the same thing but work in different ways. I believe that "research" says that the ticagrelor works "better overall" but it seemed to me that was a way to push a newer drug. I couldnt tolerate the ticagrelor at all due to the breathlessness. I have now been on the clopidogrel for about 2 1/2 weeks & am doing much better. I hope you are able to get things sorted. I have no advice on how to get it done as I am in the U.S. I do read many posts and without getting political, it seems your health system is difficult to navigate and for that you all have my sympathy. Best wishes
Thanks very much. Much appreciated. It's startling to hear how many people struggle with Ticagrelor.
Hello
I had a heart attack January 22 and had a stent fitted. I was put on a cocktail of the same meds that you are on and had the same symptoms and much more. Unfortunately, this was during Covid and I was unable to get any follow up when discharged and it was May 2023 before I got a telephone appointment with a cardiologist. I developed a severe cough and muscle pain and was very unwell. My GP referred me for chest X-ray and I had bad scarring on my lungs. I was then referred to hospital for further scans and was under the care of a consultant for lung cancer. By this time I was coughing up large amounts of blood and feeling very poorly indeed. I had never had any problems before my heart attack. Because I was unable to speak to a professional, I had to make some scary decisions myself such was my quality of life. I stopped taking the statin, (muscle pain) ramipril ( severe cough) and asprin (coughing up blood). Within a couple of months the scarring had almost disappeared and was starting to feel much better. It turns out I was intolerant to these drugs. I now take LOSARTAN instead of ramipril, I remain on ticagralor instead of aspirin and I have the inclisiran injection once every 6 months (no side effects and reduced my cholesterol to 2.5 within the first 3 months of taking). I would definitely suggest you have a conversation with your pharmacist as they have more experience and knowledge of your medications than your GP and in my experience are more helpful and sympathetic. I wish you well.
Thanks so much for your reply. I'm really sorry to hear of what was a terrible journey for you. I think a change of pharmacist for me can only be a good thing. Currently they don't seem to know much if anything about the cocktail I'm currently on.
Is it that you get sudden feelings that you can't take in a deep breath? A bit like asthma? Do you have a pulse oximeter to check your oxygen levels? They are cheap and just slip on your finger. I was like you after my ehart attack and he culprit was ticagrelor. Feeling breathless yet still having normal oxygen levels is a known side effect of ticagrelor. It affected me so badly I begged my GP to change it. He wouldn't but the cardiologist swapped it to clopidogrel immediately. I found the breathless episodes really frightening.
And Yes your statin dose does sound high but remember they do more than just reducing plaque. They stabilise it and prevent bits breaking off and causing heart attacks. You are on it more for that than to reduce cholesterol. I wouldn't lower the statins at all without the cardiologist's agreement.
Ask your GP to change ticagrelor to clopidogrel. I think you will find a big difference. You could maybe try a different statin .
Thank you so much. Yes, that's exactly what it feels like! My oxygen levels are fine. They're checked at the exercise rehab I'm going to. I also find the episodes very frightening. I think the statins are probably ok. I was looking to just try and get some control I think. I shall renew my push for a conversation about Ticagrelor. Thanks again.
Good luck. It is a well known effect of ticagrelor. You are breathing ok as yoru oxygen levels show. It just feels as if you can't.
I was initially on 80mg Atorvastatin after my NSTEMI in September of last year. I was also on the same Ticagrelor as yourself. Very quickly things didn't feel right so had my Statin cut to 40mg and now I;m down to 20mg. Ticagrelor had awful side effects, breathlessness being one, so I requested a switch to 75mg Clopidogrel. It worked for me re Breathlessness so maybe worth talking it over with your GP.
Thank you. My GP won't change meds without the ok from the cardiologist but I'll have another go. It's good to know what's almost certainly causing the breathlessness.
Keep pushing. Ticegelor is notorious for side effects. My GP was dubious but I insisted on speaking with the Surgery clinical pharmacist. She agreed with me and changed my prescription to Clopidogrel. When I finally got to speak with my Cardio he agreed it was the correct course of action by the clinical pharmacist.
Thanks very much. I'm going to keep pushing.
I take Atorvastin also very breathless nasal irritation sneezing and skin irritation,80mg perscribed will ask gp if I can change it or do I need this high dose.
Hi mangofoods I am
Also on atorvastatin and have had episodes of having to catch my breath and also terrible bruising everywhere
It’s Tricagrelor- I’m off it now and no breathlessness. Cardiac hub nurse practitioner phoned consultant who had fitted my 3 stents and he advised coming off it. I was over my op 6 months.
I also had a heart attack and since then have been on 80mg artorovstatin I think this is normal for anyone after a HA.
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