These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.
High Cholesterol and Birth Control [posted 1/11/99]
Question: In January 1998 I completed a home-kit to test my cholesterol level. Too much of my surprise, it read in the 300’s. I am 22 years old, 5 feet 1 inch, and weigh 120 pounds. When I did a follow up with a cardiologist, the results came back at 472. Needless to say, this became a huge concern of mine. The doctor started me on Lipitor and took me off of my birth control and after 4 months on the medicine my cholesterol has decreased to 240. Do you think it is possible to go back on the birth control pill? I do not want to affect my health, but I am also not ready to start a family.
Answer: I doubt that the birth control pills were the problem. Restart them and see what happens to your cholesterol.
Mylanta/Zantac effects on Cholesterol [posted 1/7/99]
Question: Could the taking of an anti-acid such as Mylanta or Zantac have any adverse effect on cholesterol? I have a hiatal hernia and have so for many years. The Mylanta was prescribed at that time. I also have reflux, which presents a problem. My dosage of Mylanta is probably one to two tablespoons each night. I hate to take such controversial drugs.
Answer: Wouldn’t think so, but you can experiment by stopping it for a month and see.
Cholesterol Medications & Elevated CPK [posted 12/10/98]
Question: For the past 11 years I have been on a variety of cholestrol lowering medications, starting wiyh Questran, Mevacor, Lescol,Provaststin,Zocor and now Lipitor. All have worked at lowering my 350 level cholestrol to about 220 currently, but all (except Questran, which had only a small effect on my T. Chol) have caused an elevation in my CPK levels. For the past 10 years my CPK levels have been in the range of 300-370 mg/dl with 175 mg/dl listed as normal max. My doctor in the past has been concerned about these levels but more concerned about the cholestrol level. I have no muscle soreness or any other symptoms. My kidney function appears to be normal. I have been unable to find any info on long term consequence (other than possible kidney effects) with elevated CPK. My new doctor feels I should stop the Lipitor. I have concerns about this as it seems my choice is heart disease or damaged kidneys. Is there a range of eleveated CPK that is considered ‘safe’ longterm? Are there other problems associated with elevated CPK? Thanks for the help!
Answer: Most physicians and the company would recommend stopping the HMG Co A Reductase drugs if you have an elevation of CPK. Usually, bigger doses of Questran will work. Also, Lopid should not have this interaction.
Cholesterol & Problems [posted 12/04/98]
Question: I am a 37 year old woman who has had elevated cholesterol readings for the last 11 years. In spite of modified diet and regular aerobic excercise, my cholesterol level has fluctuated from 203-282, back and forth over the years. No matter how much I excercise, my HDL has never been any higher than 41, and no matter how much I restrict my diet (short of becoming a vegetarian), my LDL levels and Triglycerides remain high. My ratios have been as high as 7:1. This is extremely frustrating. Since I am not overweight, have low blood pressure, and do not smoke, my doctor has not recommended cholesterol lowering medication, even though heart disease runs in the family. My maternal grandmother had a heart attack at 54, and my Dad had a heart attack at age 60. He says that although medication would lower my numbers, he’s not sure that medication would be appropriate at this time. He feels that “down the road” it may be indicated. I guess I’m wondering what he’s waiting for and at the same time, wondering if I should get a second opinion. He is concerned that since I’m only 37, I could be potentially taking this drug for 50 years. He mentioned possible side effects concerning liver function. I don’t want to solve my cholesterol problem by potentially creating a problem with my liver! I would like some advice regarding long term health risks (re: liver function) associated with the use of Lipitor and whether these risks would be outweighed by the long term benefit of lowering cholesterol levels before a problem with my heart develops. I’d appreciate any information you could give me.
Answer: Most physicians would treat you with some lowering agent with your family history and your low LDL. As to the risk/benefit, this is currently under research by the NIH. This is an area which has been neglected by the NIH. I would recommend treatment until further research comes in;but, would not push the dosage and warch closely for toxicity. Also, Vitamin E(400 units or so a day) might be a benefit. This has been shown to reduce cardiac risk without much/any toxicity. This issue is a style thing-some physicians would treat some not until more data is available. With your family, I would opt for treatment. Also, you might check your homocysteine levels-if elevated might be an additional factor to consider. Lastly, unless there is a high risk of breast cancer, you need to be on estrogen when you hit menopause.
High Cholesterol & High Triglycerides [posted 12/01/98]
Question: Initially was diagnosed with high cholesterol & high triglycerides. Lipitor was prescribed but the desired effects were not achieved at lowering triglyceride levels. Was sent to a specialist who prescribed Niaspan (niacin) in addition to the Lipitor. Currently, am taking 40mg Lipitor & 2g Niaspan daily. Both cholesterol & triglycerides are dropping, but am concerned about any dangerous interactions between the two. Will I have to continue monitoring blood/liver CPK levels every 6 weeks? Should I be cautious when taking any OTC med. or when taking daily multivitamins?
Answer: Well, I think lowering triglycerides is pointless unless they are above 2,000 (which gives a risk of pancreatitis). Not every physician would agree with me. But Framingham data shows minimal correlation between elevated trigs and coronary artery disease. However, if you need to lower your trigs you need to monitor it closely for the first 6-9 months, then you can usually lower the frequency of monitoring unless you increase your dosage. The tests are correct and the frequency correct. But, the frequency will decrease over time(for most physicians).
High Cholesterol [posted 11/25/98]
Question: I am a six foot 270 lbs male. I recently had my first physical in six years. My cholesterol was approx. 197, triglysorides 402 and my HDL 25. I went back today to have more blood drawn for liver function tests. From what I have been told and figured out on my own, I need to cut back on sweets and to lose weight. Is this all I need to worry about or is there something more serious I need to be looking for?
Answer: A cholesterol of 197 isn’t bad; but, could be better. The problem is that your LDL(bad) cholesterol is high relative to your HDL(good) cholesterol. Exercise and losing weight will improve these numbers from just OK to very good.
Lipitor & Chlosterol
Question: I have been taking Lipitor 10mg for the past six months for high chlosterol. The reading has decreased from 6.2 to 4.3 which is very good according to my G.P. My question is , will this be a lifetime medication, and is the cost going to decrease? I pay 205 dollars canadian for 100 tabs.
Answer: The options for lowering cholesterol are losing weight and strict fat restriction in the diet. This can lower cholesterol-short of this you’re in for the duration. You might be able to lower costs by buying the 20 mg and cutting them in half. This is certainly true in the states. Also, check the price in Mexico. Many of my patients go to Mexico to fill Rxs for cheaper.
Low HDL
Question: I am a 72 year male. Had a heart attack and then an angioplasty. All my cholesterol readings are great except my HDL of 33 won’t increase. However, my potassium serum is just above max at 5.2. My Sodium serum is low at 135. My BUN is high at 27. My Creatinine serum is high at 2.1 Three questions: 1. Is there heart risk with a high potassium and low sodium ? 2. Is there kidney risk with the high BUN and Creatinine? 3. How far above or below the normal range can each of those be without really being a serious problem. What can I do to improve, individually, each of these?
Answer: Doesn’t seem to be. Very high levels like 5.5-6.0 can cause a problem; but, less likely if it is chronic versus acute. The kidneys are already functioning at less than 100% to get this level of Creatinine. A normal creatinine is up to 1.6 or so. This is high-although still a way from dialysis. This would indicate either an outlet problem with your prostate or flow limitation due to vascular disease to the kidneys. Other causes would include the use of ACE inhibitors or excessive diuretics. I’d check on the kidney issue-the potassium is not a big deal and probably will correct if your kidneys start to work better.