Choosing a cholesterol drug or statins? LDL cholesterol high?

ScenarioWe go for our annual blood test. Then we notice on lipid studies section stated our LDL-cholesterol is high. Then what we usually do? Go to see a Dr, Dr start us on statins, then asked to come and check for our cholesterol lelvel after 4 months?

We was told that LDL will clog our artery and cause heart attack. So we have to take statins to lower the LDL.

But which one?

Ask the pharmacist

1) How to choose between the statins which is most suitable?

Statin of Choice	Average LDL reduction
Lipitor 10mg	36%
Lipitor 20mg	44%
Lipitor 40mg	49%
Lipitor 80mg	50%
Vytorin 10/20	52%
Lescol 20mg	22%
Lescol 40mg	25%
Lescol 80mg XL	35%
Lovastatin 20mg	25%
Lovastatin 40mg	31%
Pravachol 10mg	21%
Pravachol 20mg	26%
Pravachol 40mg	30%
Crestor 10mg	43%
Zocor 10mg	30%
Zocor 20mg	35%
Zocor 40mg	40%

Lets say the
Case 1
Patient's LDL is 4.11, and the target is 2.6 so we have to reduce by 35%. We can choose to take Zocor 20mg or Lipitor 10mg.

Case 2
Patient 's LDL is 4.91, and the target is 2.6, so we have to reduce by 48%. We can choose to take Lipitor 40mg or Vytorin 10/20mg.

By now, u should roughly know if the statins u r taking is suitable for u or not. Actually to start a cholesterol medication on a patient, we need to take many things into considerations.
Such as whether the statins taken will reduces the risk of heart attack and death rate. This is becoz even the medicine lower the LDL cholesterol, it does not mean u will have less risk of getting heart attack.
Then they also take into considerations your age, race, gender, muscle tissue damage, liver damage, kidney patients, HIV patient, warfarin patients.
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2) But is taking statins good for u?

Interesting extract from BusinessWeek
Statins drugs are the best-selling medicines in history, used by more than 13 million Americans and an additional 12 million patients around the world, producing $27.8 billion in sales in 2006. Half of that went to Pfizer for its leading statin, Lipitor.

The drugs can be life-saving in patients who already have suffered heart attacks, somewhat reducing the chances of a recurrence that could lead to an early death. But for the majority of patients, who don't have heart disease. No benefit has been found in people over the age of 65, no matter how much their cholesterol declines, and no benefit in women of any age. There is a small reduction in the number of heart attacks for middle-aged men taking statins in clinical trials. But even for these men, there was no overall reduction in total deaths or illnesses requiring hospitalization—despite big reductions in "bad" cholesterol.

A current TV and newspaper campaign by Pfizer, for instance, stars artificial heart inventor and Lipitor user Dr. Robert Jarvik. The printed ad proclaims that "Lipitor reduces the risk of heart attack by 36%...in patients with multiple risk factors for heart disease."
The dramatic 36% figure has an asterisk. Read the smaller type. It says: "That means in a large clinical study, 3% of patients taking a sugar pill or placebo had a heart attack compared to 2% of patients taking Lipitor."

Now do some simple math. The numbers in that sentence mean that for every 100 people in the trial, which lasted 3 1/3 years, three people on placebos and two people on Lipitor had heart attacks. The difference credited to the drug? One fewer heart attack per 100 people. So to spare one person a heart attack, 100 people had to take Lipitor for more than three years. The other 99 got no measurable benefit. Or to put it in terms of a little-known but useful statistic, the number needed to treat (or NNT) for one person to benefit is 100.

In an eagerly awaited trial completed in 2006, the companies compared Vytorin, ezetimibe plus a statin with a statin alone in patients with genetically high cholesterol. But the drugmakers delayed announcing the results, prompting scientific outrage and the threat of a congressional investigation. The results, finally revealed on Jan. 14, showed the combination reduced LDL levels more than the statin alone. But that didn't bring added benefits. In fact, the patients' arteries thickened more when taking the combination than with the statin alone.

IRRELEVANT LDL?

If cholesterol lowering itself isn't a panacea, why is it that statins do work for people with existing heart disease? In his laboratory at the Vascular Medicine unit of Brigham & Women's Hospital in Cambridge, Mass., Dr. James K. Liao began pondering this question more than a decade ago. The answer, he suspected, was that statins have other biological effects.

Since then, Liao and his team have proved this theory. First, a bit of biochemistry. Statin drugs work by bollixing up the production of a substance that gets turned into cholesterol in the liver, thus reducing levels in the blood. But the same substance turns out to be a building block for other key chemicals as well. Think of a toy factory in which the same plastic is fashioned into toy cars, trucks, and trains. Reducing production of the plastic cuts not only the output of toy cars (cholesterol) but also trucks and trains. In the body, these additional products are signaling molecules that tell genes to turn on or off, causing both side effects and benefits.

Liao has charted some of these biochemical pathways. His recent work shows that one of the trucks, as it were—a molecule called Rho-kinase—is key. By reducing the amount of this enzyme, statins dial back damaging inflammation in arteries. When Liao knocks down the level of Rho-kinase in rats, they don't get heart disease. "Cholesterol lowering is not the reason for the benefit of statins," he concludes.

The work also offers a possible explanation of why that benefit is mainly seen in people with existing heart disease and not in those who only have elevated cholesterol. Being relatively healthy, their Rho-kinase levels are normal, so there is little inflammation. But when people smoke or get high blood pressure, their Rho-kinase levels rise. Statins would return those levels closer to normal, counteracting the bad stuff.

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3)Conclusion of above article: In my opinion, I think those who have had a heart attack or heart disease should take statins, but for normal people which have high LDL, ask your dr's advice.
For more reading, pls refer to the article by John Carey (BusinessWeek)

We pharmacist cannot recommend statins as in Malaysia (not like UK), only Dr can. Here, we can just give counseling on how to reduce risk and check for drug-drug interactions and dispense what your Dr prescribed.

4) According to Dr Daniel Stienberg, LDL is not bad, it is the modified oxidized LDL cholesterol that is truly bad as it cause damage and hardening to the artery. So he and Dr Ray recommend to take antioxidants such as Vitamin E, C, Bioflavonoids to reduce oxidation of the LDL. So i think Exercise, eat healthily and taking supplements to lead a healthy lifestyle is the utmost important.
Suggested reading:5)So, always follow your Dr recommendations. But of course, u always can get a second opinions from another Dr if u think the Dr does not put your health in your best positions. U also can consult your pharmacist for advise on how to take the prescribed medications and also the supplements which can help u. Hehe....