Statins

[Paulagcl]

I was reading about statins -- my rheum dr wants me to take one but my primary care thinks that since imaging ofmy heart showed that there aren't blockages it was not necessary and would just increase PMR symptoms. Now I'm reading that it can cause PMR symptoms so while making this decision, don't know what to do.

[PMRpro Ambassador]

What is your cholesterol level?

[Paulagcl in reply to PMRpro]

The total is 240, but the "good" LDL is 142 out of that, triglycerides normal. So 2 drs out of 3 are okay with it given that imaging gests showed a normal distribution of it in arteries. The rhem defers to the primary care dr for everything except directly the PMR. Will see what he says now that I am off prednisone (as of last week).

[Broseley in reply to Paulagcl]

I thought the "good" cholesterol was HDL, not LDL. PMRpro ?

[Sophiestree in reply to Broseley]

HDL is the good part LDL the bad

An easy way to remember is H being Happy and L being lousy!

[PMRpro Ambassador in reply to Paulagcl]

HDL is the "good" cholesterol. However - at your age, I think I'd be less than enthusiastic about statins and especially if 2 out of 3 doctors think it is fine.

[Blearyeyed]

What reason did the Rheumatologist give you for starting statins? Getting symptoms with statins is very individual and can often be improved by finding the brand that suits you and having a lower dose than usual often just routinely given.

I had side effects with Atorvastatin, usually the first stain option offered in the UK but also the statin which receives the most complaints for causing side effects. I now take Rosuvastatin and Ezetimibe ( I have Familial HyperCholesteroleimia so my cholesterol level does not improve from diet and lifestyle changes , it's a very common but little discussed health issue).

I've had no issues with Rosuvastatin and I know many people whom use it with no side effects.

A tip with any statin is to start on half the recommended dose for 2-4 weeks to see if you tolerate it and allow your body to get used to the change and then go onto the full dose your are recommended after that adjustment period.

It's good to make sure what your nutrient levels are before starting them to help prevent side effects from occurring . Often statins like steroids and PPIs , among other medications can affect how well you absorb nutrients from you diet no matter how good it is , and the combination of Vitamin B 12 , Folate or Vitamin D insufficiency ( very low level but just in normal range) or Anaemia can be made worse by taking medications long term , and it's this insufficiency that can be the cause of the side effect symptoms.

Get your full blood count , Ferritin/ Iron, Vitamin B12, Folate , Kidney function ( electrolytes ) and Liver Function, Total Cholesterol, and HbA1c Diabetes blood tests done as a baseline and get a copy of the results as doctors will often say things are normal when you are at the lower end of the ranges , a time when many people begin to have deficiency symptoms, and a better time to change the diet or take supplements, especially when you are on medications to prevent the problems and increased drug side effects that can occur.

A combination of inflammation and taking various medications as well as statins can also cause internal dehydration ( your body is dehydrated but you aren't thirsty). Recurrent dehydration can also be the combined cause for having more side effects symptoms from statins especially ones associated with pain and fatigue, so increasing fluid intake often eases the pain felt in the joints and muscles and improves energy levels.

Of course , the big question is , why do you need it?

If you haven't got any arterial plaques yet and have a normal or low cholesterol test , are you having this suggested because of family or personal medical history which would mean it was a sensible preventative for you to take now.

People aren't just put on statins to reduce cholesterol but often as a Preventative for causing plaques or blockages that could be more likely to occur in certain patients with a particular family history of heart disease, peripheral arterial problems, or strokes.

If you haven't any of these Familial health concerns and your cholesterol levels and arteries are fine it wouldn't appear that you would need a statin , which is why it may be worthwhile to contact your Rheumatologist to find out why it was medically and specifically that they recommended by them that you take one. If there is no reason then it seems unnecessary to take it " just in case" , you could just carry on eating a healthy diet, use plant sterols, hydrate, and continue moderate exercise instead.

Take care , Bee

[Paulagcl in reply to Blearyeyed]

Thanks for the reply! I have high cholesterol, though the "good" cholesteral has been considered a factor that kept my last dr from suggesting a statin. This dr did a heart scan and felt what he was was normal and didn't reqjire a statin, but now suddenly he asked if I want one. I need to ask him why he suddenly said that. I think he was concerned that it would make the PMR symptoms worse. The rhematologist leaves it to my pc dr to make such decisions.

[Karendeena in reply to Blearyeyed]

Hi there, I have recently been put on a statin as my cholesterol has increased from 5 to 5.16.I couldn't tolerate Atorvaststin, after a couple of weeks my hips and thighs ached and I was weakened, I couldn't even walk up the stairs without aching. I have been taken off it and the GP is trying another one when I return from holiday at the beginning of September. I think it's the same as you are on. I hope this works for me too

[Polygolfer]

I was explained by my parents cardiologist that statins will not ‘unblock’ your arteries!! They are useful in preventing your arteries from blocking further hence reducing (but not avoiding) your risk of strokes and heart attacks. I take a small dosage so interaction with statins was not an issue at the time, not sure at higher doses but your GP should be able to answer that. Statins, like many drugs, also have side effects so it’s all a juggling act to decide if it’s worth taking them or not.

[marionofnorwich in reply to Polygolfer]

What is considered a small dose? I am following this as I have stopped taking statins recently as I have had a lot of lower leg pain but can't work out what is causing it so I have stopped everything other than pred and Adcal and will re-introduce statins - once I get benchmark blood tests back. I have been on Lipitor ( atorovastatin) 20mg. my last total cholesterol was 7 and my rheumie thought I should take it, but I haven't had any scans to date

[Polygolfer in reply to marionofnorwich]

Your doctor should be able to answer all your queries about the interplay between the drugs you’ve been prescribed. As a personal experience I would not drop, restart, or take up any drugs unless under medical supervision and agreement.

[marionofnorwich in reply to Polygolfer]

I have kept in touch with them all along but their knowledge is really variable. I don't normally see the same doctor twice and although they engage well with me, I don't always feel they know the details. For example the doctor I saw yesterday looked a bit blank when I took a bottle of Vitamin D3 and K2 in with me and said I was proposing to take them (while in hospital a blood test showed I was low/underpar with Vitamin D and was given a high dose for three weeks). While I was in hospital, I was running masterclasses from my bed in PMR with the nurses, including one that is a PMR sufferer and really didn't know enough just for her personal care. I am not dissing the doctors but I don't think they can keep up especially the newer medics so I feel that I need to educate myself and then check with them. I have also tried talking to pharmacists about timing of medications and how they affect each other in terms of absorption but again, blank looks and moreoreless 'it says on the label, twice a day' attitude. Don't worry though, I am not going rogue and keep testing and recording my blood pressure and asking for cholesterol tests to monitor

[Blearyeyed in reply to marionofnorwich]

If you have Vitamin D insufficiency that can also cause bad muscle and joint pain especially during activity and numbness and tingling and difficulty in movement and balance.So. it would be a good plan to take the Vitamin D with K2 until you go back in September and request a blood test to see if it has improved because the symptoms you were experiencing feel similar to those people relate to a statin issue.

If they didn't check your Vitamin B12,Folate and Ferritin while you were in hospital do ask for those to be tested in September as well, because a deficiency in these can cause recurring Vitamin D problems , and although the doctors assume a three week high dose will solve the problem and don't think they need to check it it doesn't always solve things especially if you have B Vitamins deficiencies as well, as I know from experience,

I took high Vitamin D for eighteen months and had to push for tests to prove it was still insufficient.At one point it even got lower before they finally spotted my B 12 and Folate Deficiency . It wasn't until I had been on injections and supplements for B12 and Folate for six months that my Vitamin D and Iron levels began to rise. Without the B vitamins the metabolism and recycling if Vitamin D and Iron isn't completed properly.

Most doctors, pharmacists and nurses ,I'm sorry to say, know very little about Nutrient Deficiency and neglect to do the regular testing you are recommended to have when taking various medications including steroids, NSAIDs, antidepressants used for pain and PPIs. They always assume a basic short term oral supplement will solve the problem because they haven't learnt the common reasons that this may not be enough and if we take medications that are absorbed via the stomach and are not of an active, simple form.

[PMRpro Ambassador in reply to Polygolfer]

I have yet to meet a doctor who was fully au fait with drug intereactions, And a lot don't even know how to use interaction checkers ... You have a touching faith in their knowledge - they usually refer patients to the pharmacist.

[Paulagcl in reply to PMRpro]

He DID check interactions. That's why he hesitated to give me a statin, which most doctors here hand out right and left. I don't have "touching faith" in him. I do my own checking and if I question something, he looks it up if he isn't sure.

[PMRpro Ambassador in reply to Paulagcl]

Actually Paulagcl, I wasn't replying to you - I gathered you and your doctor were being very thoughtful and not just ticking boxes.

The comment was directed at Polygolfer. HU can be so confusing though it does say on a comment replying to someone other than the thread originator but you also get notified.

[Paulagcl in reply to PMRpro]

OK, I wondered -- it is sometimes confusing the way the messages show up on my computer

[Blearyeyed in reply to marionofnorwich]

They won't necessarily give you any scans in the UK before recommending you begin a statin , they usually just base the suggestion on your cholesterol blood tests, medical conditions and other medications taken, family history , age and weight/ BMI.I personally chose to take half the dose I was originally recommended for four weeks to check my tolerance and adjust to taking the new pill before increasing to my full dose. I take Rosuvastatin ( Crestor) as I , like many , had issues with Lipitor.

[Paulagcl in reply to Blearyeyed]

I don't think scans are routine here in the USA -- it is up to the dr. My dr was concerned about muscle pain given the PMR so he did the scan to see how things looked right now. His wife is also a dr and this is what she did for herself before deciding whether to take it, so I feel like I always am getting two oinions from him.

[PMRpro Ambassador in reply to Polygolfer]

Actually - statins stabilise atherosclerotic plaque to reduce the risk of bits breaking off and forming clots but they do also result in reduction of the plaque.

ncbi.nlm.nih.gov/pmc/articl....

health.clevelandclinic.org/...

[Polygolfer in reply to PMRpro]

Few studies only and even then reduction is small… main aim is to prevent increase in plaque accumulation

[Blearyeyed in reply to Polygolfer]

It's actually a combination of preventing new plaques from occurring ,and, if you have plaques, stabilising the plaques that already exist and preventing them growing larger or becoming fragile in shape which increases the risk of them having parts break away.The studies available on these improvements were actually of a high quality and are well regarded by cardiologists generally worldwide.

[Polygolfer in reply to Blearyeyed]

Exactly, agreed!

[marionofnorwich]

I am no expert but if the GP has done personal imaging that is more relevant that the statistical likelihood of needing them.