cholesterol and lipitor

[bufguy]

I have been on Atripla for 14 months now. I am undetectable with a CD4 of 615, CD4% 36. I'm 48 yo, 6-1, 190lbs with a blood pressure of 122/72. I rack up 30 miles per week running or on the elliptical.
There is no history of heart disease in my family.
Recently my cholesterol was tested at 189, triglycerides 60, HDL 60 and LDL of 121.
My doc says my LDL is high (should be under 100) and suggested I start Lipitor.All the other numbers are good though.
I really don't want to start another med. Considering my overall health, exercize and family history what do tou think?
I don't feel there is any risk.

[Inchlingblue]

I agree with your reluctance to start more meds. I would try adding more fiber to your diet and taking a good Omega-3 supplement.

Some people take Niacin for lowering LDL, I have not personally tried it.

Here's a good recent article about lowering cholesterol:

http://health.usnews.com/articles/health/heart/2008/02/06/lowering-ldl-cholesterol-without-drugs.html

[AboutToStart]

I agree with your reluctance to start more meds. I would try adding more fiber to your diet and taking a good Omega-3 supplement.

My research shows the following drug as the best Omega-3 available (FDA approved; requires a prescription):
http://www.lovaza.com/consumer/lovazaisdifferent.html

However - says its main aim is at lowering trigs, which is not bufguy case (rather hi LDL...). He's already exercising and dieting, so what's left??

[YaKaMein]

Consider what others have suggested and see if the upward trend continues with your lipids. Ask for regular lipid panels [fasting] with your labs.They're elevated but far from dangerous levels. Like you, my lipids went out of whack with my ARV treatment. If they continue to increase or remain elevated, meds may be the only way to manage this side effect. Work with your physician to explore options, e.g a nutritionist, supplements, etc. Health concerns about cholesterol are not acute but gradual over time .... which you have on your side. -YaKa

[jjmcm]

Hey Bufguy.

I am in good shape and about the same age as yourself.  However, my HDL is lower and my Triglycerides are higher.  Most of us would love to have your latest HDL and Triglyceride readings.

The reason your LDL is higher is because your Triglycerides are so low.

The typical calculation is LDL= Total Cholesterol - HDL- (.2 X Triglycerides)

So, if your Triglycerides were higher say 149 (the upper threshold of normal), your LDL would be around 99.

Don't listen to your doctor.  Statins are not good for you, particularly someone in good shape like yourself.  Besides all the side effects, there is increasing evidence that statins increase your chance of getting cancer.   Avoid them at all cost.

My doctor is one of the best HIV/Aids doctors in TX.  I saw him today and I can assure you he would never even mention statins to you with those readings.

--JJ

[jcelvis]

Bufguy i agree with everyone else, there is no need to get on lipitor. My cholesterol is 188, tri 151, ldl 119 and hdl, 39. I probably have one of the worse family histories on the this board when it comes to heart disease. My father died at 38 of a heart attack and my grandfather on my mom's side died at 42. My grandmother died of heart disease, and every adult member of my family suffers from high blood pressure and high cholesterol. My sister who is 15 has a tri and cholesterol of 200.

My doctor watches my lipids carefully, but hasn't suggested any meds for cholesterol. My doctor is concerned about my lipids number when i start hiv meds, and you have already been on yours for 14 months.

All of your numbers are well within the normal range and your 48. Remember doctors are pressured by pharm reps all the time, and lipitor reps try to push their pill on everyone.

[bocker3]

Don't listen to your doctor.  Statins are not good for you, particularly someone in good shape like yourself.  Besides all the side effects, there is increasing evidence that statins increase your chance of getting cancer.   Avoid them at all cost.

Hogwash -- not to mention dangerous misinformation that you are spreading in a generalized way.  Statins save lives.  If you have a medical degree, then you are free to dispense advice, but telling someone to NOT listen to their doctor is incredibly idiotic.

Bufguy

Given your latest cholesterol results I think it is perfectly reasonable to push back on your doctor and find out why he seems to want you to go on statins at this time.  Given your high HDL and good total cholesterol, I dont' understand it.  However, your doctor may be putting other things into his recommendation (like a family history of cardiac issues , etc) -- so ask him.
Also, are these results typical for you or is this profile a bit different?  I certainly would always want to see more than one set of results -- unless something was astronomically off (and even then, i might want a repeat).  At the end of the day, you have to take your doctor's advice, as well as any other medical professional's advice and make your own decision on if and when to start a statin.

Good luck,
Mike
(who's been taking statins for over 15 yrs, because of high LDL, low HDL and a family history of men dropping dead before the age of 50 due to cardiac issues)

[AboutToStart]

I think that at the end of the day - it's gonna be a personal decision that you're gonna have to make.. same as starting HIV meds (when? what kind?), same as taking a baby aspirin every day, same as with supplements and minerals..

I think what's important is to look at the general trend in modern medicine... you can find Pro's and Con's for everything. But what's the trend? with HIV meds it is to start rather earlier than later.. even though not officially written in stone - most docs don't say wait till cd4 drops bellow 350.. Same with  statins - the trend nowadays, as I've been told by a doc, is to keep your total cholesterol way bellow 200 if possible (like 130-140), though the "official number" is 200. Your trigs are not bad so I don't think omega-3 will benefit you much, but a statin might.

Myself, I just started atripla a month ago so I'm waiting to see how my cholesterol number will be affected on my next lab. Pre-atripla: Trigs were great (35), hdl was good (45-50) but ldl sucked (130-150). My total cholesterol used to be (all my life) around 220-230, but lately it went down (just coz I lost weight, without any meds/suppls help) to 170-180, so I'm waiting to see what my new numbers will be after starting the atripla, but if doc's recommend taking a statin - I wouldn't think twice ( after all what's a lil statin compared to a B-I-G atripla every day  

[jjmcm]

Mike, I would appreciate it if you would not quote my reply and then claim that I am idiotic.   The purpose of this forum is to relate our experiences dealing with this disease and living in spite of it.  I can assure you I stay very well informed and don't need a medical degree to form an intelligent opinion about what I want to do with my own health.

Bufguy was asking our opinion I believe because he had already questioned the necessity of going on a statin.  If he didn't, he would not have posted here and would have said "OK" and just taken it.  I simply wanted to share with him my thoughts on why he should stay on the sideline with this decision.

Believe what you like, but statins are one of the greatest scams pushed on us by big pharma.  Besides information from my own doctor, I constantly read literature from other doctors that has convinced me that I will never take one.

Most recently in the Sept/Oct 2009 -Well Being Journal magazine an article on Cancer, Cholesterol, and Statins quoted a 2007 issue of the Journal of the American College of Cardiology which revealed that far from having few side effects, statins can significantly increase the risk of cancer.

Specifically, the increased risk of cancer has been significantly correlated with the lowering of LDL cholesterol- an unforeseen negative outcome.  With statin use, the increase in cancer deaths counteracts the supposed lower cardiac mortality associated with lower cholesterol, resulting in a neutral effect or increased overall mortality.  Translation: with statin use, even if you don't die of a heart attack, you will likely die of cancer.

This is just one of many articles I have read regarding the many risks of statins.  Mike, I will take my chances without statins, continue going to the gym four times per week, walking a couple more times, eating healthy, and taking supplements that I feel benefit my well being.  

You do what you want.   Listen to your doctor and take whatever he recommends.

I will let Bufguy make his own decision.  

--JJ

[bocker3]

Mike, I would appreciate it if you would not quote my reply and then claim that I am idiotic.   The purpose of this forum is to relate our experiences dealing with this disease and living in spite of it.  I can assure you I stay very well informed and don't need a medical degree to form an intelligent opinion about what I want to do with my own health.

I will let Bufguy make his own decision.  

--JJ

First off, I didn't call you idiotic, all I said was that telling someone to NOT listen to their doctor is idiotic -- and I stand by that.
If you read your post, you did not state your opinion, you told him what to do and presented opinion as fact -- "Don't listen to your doctor.  Statins are not good for you......".
Giving you opinion is exactly what these boards are for -- however, there are folks who believe everything they see (I'm not saying that Bufguy falls into this category) and telling anyone that they should simply disregard their doctor is simply WRONG.  Read how I worded my response -- I didn't tell him he should or shouldn't take statins, I suggested he ask his doctor for his reasoning and then make his own choice given this information.  Ultimately, we are saying almost the same thing -- however, I did not try and convince him by presenting only one side of the statin argument.  Even your rebuttable presents it like statins = cancer.  Again, this is misinformation by presenting only a piece of a scientific article that seems to be interpreted by a non-scientific magazinie.  I can't believe that any peer reviewed publication whould say, "Translation: with statin use, even if you don't die of a heart attack, you will likely die of cancer".  If you think about -- cancer chances increase with age, in general, so if statins keep you from dying of cardiac disease, you DO have a greater chance of developing a cancer -- simply by living longer.

Mike

[sharkdiver]

furthermore, correlation does not equal causation....

[jjmcm]

Mike, if I did everything my doctors told me to do over the years I would be dead by now.  I think that is one of the reasons that each of chooses to seek out additional information from other patients rather than accept only what our doctors choose to tell us and just as importantly what they do not.

I am sure Bufguy is a big boy and can discern what I meant about not listening to his doctor on this point.  In other words, I agree with the other posts besides you that recommend waiting to consider a statin. 

I don't like your word "misinformation".  I provided a sample of some of the risks associated with taking statins.  The quote is from a magazine article that quotes The American College of Cardiology.  Are you more knowledgeable than them?  Of course, the last sentence in the quote is the opinion of the magazine article's writer.

You on the other hand have offered NO information other than your valued opinion.

And, I stand by my original statement.  Statins are not good for you.  Here is another opinion:

A review of the literature by the Department of Medicine at the University of California, San Diego, cites nearly 900 studies which show adverse effect of statins, which are widely used in treating high cholesterol. Researchers report that muscle adverse effects are the most commonly reported problem in the literature and by patients. Adverse effects are dose dependent, and risks are amplified by drug interactions, thyroid disease, high blood pressure, diabetes and genetics.

The risk of adverse side effects goes up as age goes up, and this helps to explain why statins benefits have not been found to exceed their risks. Unfortunately, researchers report the physician awareness of statin side effects is low.

Statin side effects may include:
Increased cancer risk
Sexual dysfunction
Immune system suppresion
Cognitive loss
Neuropathy (numbness, tingling in extremities)
Anemia
Cataracts
Hepatic dysfunction.
Pancreatic dysfunction

Mike if you think statins are helping you, take them.  Anyone else here is an independent operator and can do the same.  However, don't insinuate that I am posting bogus hogwash that does not have ample information to back it up. I will continue to recommend that everyone question their own doctors, do their own research, and make choices they are comfortable with.

--JJ

[Giblarry]

Niacin could help you lower your LDL.  It also is the only substance proven to reduce plaque in the arteries. 

Your chloresterol isn't scary high, but dietary adjustments would bring it down without meds.

The good news is your triglycerides.  60 is a very good number.  High triglycerides have been a problem for some HIVers.  From my own experiences, high tri's are a pretty good indicator of a possible cardiac event.  No fun candy gun!

Gib

[sharkdiver]

Thanks Giblarry, for getting the thread back on track. Niacin is good but it can tax your liver at the recommended doses (if you are prone to elevated liver enzymes). 
Has your doctor recommended fish oil? there are many benefits with that.

From personal experience, although I have a good diet, and daily exercise, I have hyperlipidemia especially with my triglycerides (you would be scared). I have been hospitalized with pancreatitis 4 times (for a little over a week each time) over the past 3 years. I can only imagine how high my lipids would have  been without lipid lowering meds (they have lowered significantly since beginning a protease inhibitor-free combo).

With HIV meds, unfortunately you might someday have to deal with high lipids, no matter what you do with your diet or exercise. Hopefully not too soon

[bufguy]

Thanks for all the responses. As you may see from my profiole I started Atripla with a CD4 of 511, so I am not adverse to medication. My point was that I exercize quite dilligently, I have no family history of of heart disease and ALL my other numbers were good. Shouldn't an elevated LDL be only one consideration in deciding another medication. Maybe I've already made up my mind, but I just want to see what other people think, especially those that may have had a similar experience.

[YaKaMein]

Hey Buf,
Absolutely take your time to decide. There's no need to rush to judgment based on the clinical information you have. Even with much higher numbers for lipids, I deferred treatment for a year. I have faith that you will carefully consider this and make the best choice for you. Unlike HAART, it may be a temporary period you might try Lipitor or some other med for cholesterol. Let us know how you proceed. -YaKa

[bufguy]

Just got my labs from my 8/7 office visit. In addition to my undetectable Vl, CD4 689. CD4% 35 .

My cholesterol is now 173, LDL 97, HDL 63, triglycerides 63. Looks like no lipitor for me.
Next labs will be in December.

Again thanks for everyone's help!

[aztecan]

Just got my labs from my 8/7 office visit. In addition to my undetectable Vl, CD4 689. CD4% 35 .

My cholesterol is now 173, LDL 97, HDL 63, triglycerides 63. Looks like no lipitor for me.
Next labs will be in December.

Again thanks for everyone's help!

That is super. As one who has been fighting the war on lipids, and losing, I must say I envy you.

I had to change regimens to get mine to drop.

HUGS,

Mark

[Lou-ah-vull]

I think I found the lipids he lost.... can I give them back?  Started zocor two weeks ago because my hi tris and hi LDL and lo HDL is not correcting itself even with diet and exercise.  Congrats on your good numbers.

Gary