Advice on reducing medication

[Lovecanoeing]

I had my first heart attack mid-2017, resolved with a stent and placed on the NICE cocktail of meds.

After approx 1 year I was taken off Ramipril and Bisoprolol and was moved from 80mg Atorvastatin to 10mg of Rosuvastatin, along with the aspirin. My bloods and cholesterol have continued at normal levels and I have been maintaining a normal life with plenty of exercise.

However, in September I suffered a second heart attack and was treated to two more stents, including one in the LAD (end of October). I was put back on the NICE standard cocktail of meds.

I feel basically reasonably fine and have resumed regular exercise, although trying to maintain a lower HR threshold. The Consultants who treated me suggested given my experience that I needed a more aggressive medication strategy going forward (including I should never go below 40mg of Atorvastatin).

This week I had an echo scan which showed "normal" function, such that my local cardiologist has determined to take me off the bisoprolol and move from Astorvastatin 80mg to Rosuvastatin 10mg ("side effects outweigh the benefits"), keeping me on 3.75mg of Ramipril and the aspirin.

Reflecting since the appointment, this approach does not sit comfortably, such that I have not at this stage adjusted my medication. Before having what could be quite an uncomfortable conversation with my cardiologist I would ask if anyone has had similar experience of reducing medication so soon after treatment and then also in effect the wisdom of questioning the judgement of your cardiologist? 😰

[Lowerfield_no_more]

I would be asking the question of myself, what do I know about heart based medication that means I am able to challenge the view of a cardiologist who has, no doubt, years of experience in his field and seen many patients in front of him/her. People on here can only give you their experiences which may be very different to yours, and perhaps not a good basis upon which to make a decision which could affect your life and certainly no-one should be encouraging you to go against the direction of your health professional, since that is a matter between you and them, and is against our community rules. But if I you need a second opinion why not talk to a pharmacist who is qualified to give a view on medication needs, perhaps equal to your cardiologist.

[Lovecanoeing in reply to Lowerfield_no_more]

Totally agree that I know nothing compared to an experienced qualified cardiologist. I also made the mistake to ask advice from ChatGPT, only for that to contradict the position of my local cardiologist. After reflecting, I am going to discuss further with the local cardiologist, but was seeking other's experience before doing so.

[Jaybbb in reply to Lovecanoeing]

You say "I know nothing compared to an experienced qualified cardiologist". I do not buy that. You, a patient, must educate themselves to the point of being able to FULLY understand what level of medication one should be on and, if possible, to monitor lab reports to confirm the affect that med has on you. I recently had a cardiologist put me on 10 MG of Amlodipine. I challenged that based on my bp readings, and went on 5 MG. My bp readings are fine with 5 MG. And if I have problems in the future with this low dose of Amlodipine, I will recommend that I go on Losartan. The patient must be aware, self-educated, informed, and be in the copilots seat, not a passenger that goes wherever the pilot wants to take him.

[Hoocher62]

I had a widow maker HA in 2019. I had normal BP and Cholbefore my HA which was caused by various plaque break off, resulting in a blood clot. I've since asked if I can have meds lowered, however, My cardiologist won't reduce my 80mg of atorvostain as she says its the best thing to stop plaque loosening again.

[aardvark68]

Just in case you weren’t aware, 10 mg of Resuvastatin is actually as strong as the 80 mg of atorvostatin that you were prescribed before -

Results of clinical trials indicate that rosuvastatin is either 2 or 4 times more potent than atorvastatin (ie, atorvastatin dose must be 2–4 times higher …

[Carriefarm]

I would be asking why, when your cholesterol was under control and you were using a statin, that you had a build up of plaque again that required stents. Rosuvastatin, apparently, is one of the best statins for reducing cholesterol.

[Lovecanoeing in reply to Carriefarm]

That's my challenge; if I go back to the previous statin dose, despite it maintaining a "normal" cholesterol level, am I putting myself at an avoidable risk of a repeat incident. I've pretty much decided I'm going to "bite the bullet" and have the difficult follow up discussion with my cardiologist.

[Jaybbb in reply to Lovecanoeing]

After being on rosuvastatin and at least 5 or 8 other statins, I always had the same results: extreme muscle pain, stomach problems, extreme tiredness. Off of all statins, and went to Repatha which is much more effective (for me) than any statin. Bringing all my lipid panel numbers to half what they were, and well into the normal range.

[Lovecanoeing]

Many thanks for this feedback. Clearly there is a big difference between 2 and 4 times. I was on 10mg of Rosuvastatin for the last 2-3 years and when I was admitted with a heart attack my cholesterol was apparently "normal" at around 3.5 and the health of my heart had deteriorated in that time (EF over 60% in 2020, 43% in September 2024 - appreciating this is not the only measure of heart health). Hence in the initial treatment the doctors were suggesting a more aggressive medication strategy in my case. So I am surprised the local cardiologist would be suggesting to move back to a statin dose that evidently was not sufficient in managing a healthy level of cholesterol (appreciating this is not the only factor).

[GoodTea in reply to Lovecanoeing]

The 10mg Rosuvastatin will reduce 'bad' (LDL) cholesterol levels to a similar extent as 20mg Atorvastatin. With 10mg Rosuvastatin, you will still be on a high-intensity statin regime. See the Table headed "Extent of Lipid lowering with Available Therapies" :

england.nhs.uk/aac/wp-conte...

Well worth asking your cardiologist to explain why it is better for you to take Rosuvastatin rather than Atorvastatin. It could be that your most recent blood tests show that Atorvastatin is leading to unwanted side effects and/or an unwanted interaction with other meds.

Hope you get the issue clarified and have time to post the explanation here. Most posters are concerned with being over medicated rather than under medicated so your post has sent my curiosity into overdrive!

[Qualipop]

Rather than challenging him, why not ask him to explain why , in his opinion, is your treatment regime correct for you. A slightly different approach may get better results.

[Lovecanoeing in reply to Qualipop]

I’m with you on this. Sorry my English was not clearer. Definitely requires a diplomatic sensitive approach to the cardiologist.

[Farmer63]

Really surprised that you're cardiologist reduced your statins from maximum dosage to almost minimal dosage. Universally it is recommended by most cardiologists that anyone who has a heart event, heart attack, that they should be on maximum statin dosage for life. Rosuvastatin maximum dosage is 40 mg, that is compared to 80 mg of Atorvastatin. These maybe the cause of your second heart event.

[DWizza]

I have recently written to my cardiologist asking if my current dose of 10mg Rosuvastatin is sufficient based on results taken in June last year

Serum cholesterol 3.4

Serum HDL 1.5

Serum non HDL 1.9

Calculated LDL 1.4

Serum triglycerides 1

Serum cholesterol/HDL 2.3

Having had issues in 80mg artovastatin (not offered a lower dose) then had a trial stop of about 8 weeks and felt fantastic. Was put on 40mg pravastatin and started having issues within a week. Was put on the 10mg Rosuvastatin and feel ok but not had any follow/feed back since the June test. It was all done through GP surgery and sadly I don’t trust their oversight. One has to be on top of everything.