Who here is on a statin?

[Sicsemptyran]

Taking a statin from 10-20mg instead of adding Zetia isn't really a "horrifying" thing as I'd imagine they will both get you to the same place in the end. It seems that Zetia at the moment in American medicine seems reserved for those that have maxed out their statin dosages. She also told me that she viewed Lipitor and Creator as "interchangeable" bc I asked why she didn't prescibe Crestor. Taking this damn pill before bed instead of in the AM isn't always easy to remember. It's frankly, stupid if I can take a pill with a longer half life in the morning for the same effect.

The horrifying thing was not referring to the statin piece, not at all saying it’s horrifying for a doctor to say to go from 10 -> 20mg of a statin haha!

 

[BamaCrazy]

I just received my CT CAC Scan results 1 hour ago. My Total Calcium Score is 0 with a percentile ranking of 0-25%. And my regional non-cardiac anatomy is normal. My Doc says I’m the first person he’s seen over 50 receive a score of 0.

Heart disease is hereditary in the men in my family so I am pretty happy about the results. I’ve been on Rosuvastatin for several years so it must be helping.

I also had bloodwork this morning and included Lp(a) and apolipoprotein B (apoB) this time. Hopefully those results are also positive.

 

[NotHuman]

It very rare people who take this kind of dose of BP didn’t have also a prescription of betabloquer

Most people who use an ARB are also on a beta blocker? That’s interesting. I’d love to see your source for this so I can learn more.

 

[NotHuman]

I appreciate your note regarding telmisartan.

Agreed regarding the tone and apologies to all for allowing that to devolve into insults, I took umbrage with broad statements I found unfounded and that I thought could lead to harm, but doesn't excuse it all the same.

Mature as fuck post right here. Respect

 

[egruberman]

I just received my CT CAC Scan results 1 hour ago. My Total Calcium Score is 0 with a percentile ranking of 0-25%. And my regional non-cardiac anatomy is normal. My Doc says I’m the first person he’s seen over 50 receive a score of 0.

Hell yes. Congratulations on winning the genetic lottery.

That said, might be worthwhile to test again in a few years to back up the result.

 

[egruberman]

Taking a statin from 10-20mg instead of adding Zetia isn't really a "horrifying" thing as I'd imagine they will both get you to the same place in the end. It seems that Zetia at the moment in American medicine seems reserved for those that have maxed out their statin dosages. She also told me that she viewed Lipitor and Creator as "interchangeable" bc I asked why she didn't prescibe Crestor. Taking this damn pill before bed instead of in the AM isn't always easy to remember. It's frankly, stupid if I can take a pill with a longer half life in the morning for the same effect.

10-20mg isn't "horrifying" per se, but it's pushing the dose further down the flat line of the dose response curve which leads to a greater likelihood of adverse side effects. Myalgia, tendon issues, insulin resistance all occur at higher doses. A max dose of Atorvastatin generally yields type 2 diabetes in 1/3 of patients after a few years, a fact which then causes me to wonder why in the fuck anyone would want to push statin monotherapy to the max dose.

Rosuvastatin and Atorvastatin are fundamentally different in how they are metabolized. Yes, they are used interchangeably, but that doesn't mean they are the same. Rosuvastatin is more potent on a per milligram basis. Is hydrophilic, doesn't cross the blood/brain barrier, nor tax the liver quite the same as Atorvastatin.

I personally believe it's just inertia. The clinical trials (from a couple decades back) all used very high doses to guarantee a positive response in a population that was at very high risk for whom anything other than the max dose would have been unethical. Which has led me to the conclusion that the medical community is really focused on treating MACE rather than the disease itself. As though it's inevitable that you're going to have a heart attack, but once you do, they'll treat you.

 

[BamaCrazy]

Hell yes. Congratulations on winning the genetic lottery.

That said, might be worthwhile to test again in a few years to back up the result.

I want to thank you for your feedback, knowledge and insight. For every 5 trolls, and 10+ members using this forum purely as a marketplace, there are many more of us here learning valuable health information, advice, and real life experiences that could make a difference in future outcomes.

 

[Anonymous35]

You can't say that. Pharmacist did medicine school, 6 years of studies and have responsabilities. You did a 2 years pretty easy diploma. Don't lie to yourself. I know that I did the DEUST préparateur en pharmacie

I don’t lied to myself lmao it exactly what i have said doctor in pharmacy for pharmacist
And degree bachelor to work at hospital which is true
With only the deust you can’t work at the hospital buddy or maybe you can but they will forced you to do the degree

And no we have the same responsabilities, at the exception if they own a pharmacy which is different

If i did a mistake i can get fired to the same extent as a pharmacist simple as that

 

[Anonymous35]

Sadly a lot of the professional societies are incredibly behind the times. The endocrinologist society doesn't recommend testing vitamin d in any patients due to the "cost", despite cash pay for the test being under $20. As @egruberman says, anyone can know more about a subject than anyone else, and it is on patients to educate and advocate for themselves as well as try to find doctors who do the same. My wife is a doctor and what she sees other doctors recommend in certain situations horrifies us both.

Especially vitamine D is cheap and nearly everybody lack of it
…

 

[Anonymous35]

10-20mg isn't "horrifying" per se, but it's pushing the dose further down the flat line of the dose response curve which leads to a greater likelihood of adverse side effects. Myalgia, tendon issues, insulin resistance all occur at higher doses. A max dose of Atorvastatin generally yields type 2 diabetes in 1/3 of patients after a few years, a fact which then causes me to wonder why in the fuck anyone would want to push statin monotherapy to the max dose.

Rosuvastatin and Atorvastatin are fundamentally different in how they are metabolized. Yes, they are used interchangeably, but that doesn't mean they are the same. Rosuvastatin is more potent on a per milligram basis. Is hydrophilic, doesn't cross the blood/brain barrier, nor tax the liver quite the same as Atorvastatin.

I personally believe it's just inertia. The clinical trials (from a couple decades back) all used very high doses to guarantee a positive response in a population that was at very high risk for whom anything other than the max dose would have been unethical. Which has led me to the conclusion that the medical community is really focused on treating MACE rather than the disease itself. As though it's inevitable that you're going to have a heart attack, but once you do, they'll treat you.

I agree i’ve seen strong dose a statin a lot
80 mg of atorvastatin
This is a lot

But yeah 10/20 of atorvastatin is moderate

If you want the equivalent dose is this
5mg rosu= 10 mg atorvastatin
20mg simvastatin = 10mg atorvastatin
10mg simvastatin = 20mg pravastatin
So as you can see the strongest is rosuvasatatin and the safest is pravastatin

 

[Anonymous35]

Most people who use an ARB are also on a beta blocker? That’s interesting. I’d love to see your source for this so I can learn more.

From the prescription that i have when i worked at the hospital that i see daily

 

[jtmarlin]

10-20mg isn't "horrifying" per se, but it's pushing the dose further down the flat line of the dose response curve which leads to a greater likelihood of adverse side effects. Myalgia, tendon issues, insulin resistance all occur at higher doses. A max dose of Atorvastatin generally yields type 2 diabetes in 1/3 of patients after a few years, a fact which then causes me to wonder why in the fuck anyone would want to push statin monotherapy to the max dose.

Rosuvastatin and Atorvastatin are fundamentally different in how they are metabolized. Yes, they are used interchangeably, but that doesn't mean they are the same. Rosuvastatin is more potent on a per milligram basis. Is hydrophilic, doesn't cross the blood/brain barrier, nor tax the liver quite the same as Atorvastatin.

I personally believe it's just inertia. The clinical trials (from a couple decades back) all used very high doses to guarantee a positive response in a population that was at very high risk for whom anything other than the max dose would have been unethical. Which has led me to the conclusion that the medical community is really focused on treating MACE rather than the disease itself. As though it's inevitable that you're going to have a heart attack, but once you do, they'll treat you.

Oddly enough she just offered me choices after my month 2 bloods on 10mg Lipitor came back w/LDL of 102 which is still too high. She said I can go to 20mg Lipitor (her advice), add Zetia or add "an injectable that my insurance most like won't cover unless we try the higher dose statin or combo therapy first" which I'm assuming is Repatha. I called and it does need prior authorization. Anyone have success with the copay card on their site? What did you pay? Although I'd imagine having a calcium score in the 95th percentile in early 40s may make help with prior authorization.

 

[lilhawk]

From the prescription that i have when i worked at the hospital that i see daily

Of course you're going to see a lot of patients in a hospital setting, especially heart disease patients, post cath lab patients, that are on both drugs because they're obviously not healthy being in the hospital so much more likely to be on both. This isn't representative of the general population though. I'd say maybe 25% of people on an ARB like Telmisartan are also on a beta blocker.

 

[egruberman]

She said I can go to 20mg Lipitor (her advice), add Zetia or add "an injectable that my insurance most like won't cover unless we try the higher dose statin or combo therapy first" which I'm assuming is Repatha. I called and it does need prior authorization. Anyone have success with the copay card on their site? What did you pay? Although I'd imagine having a calcium score in the 95th percentile in early 40s may make help with prior authorization.

Goddamn, get on a PCSK9i ASAP.

Copay card is easy peasy. There are no income limitations or anything that I'm aware of. I applied, got it, and discovered that I didn't need it when I went to use it.

As it turns out, my employer has a rider on the pharmacy benefit for "preventative" meds that include both Repatha and bempedoic acid without need for prior auth.

So, do this. Get the copay card and the Rx and get it filled. There's no reason you can't add in the Zetia anyway, so do that too. Even better if you can get Nexlizet. I'd switch to Crestor at some point for greater efficacy, but do that when you're not changing anything else. Some people experience sides with one or the other.

Look at it like this. You're in the process of dying from this disease. The calcium score is proof of that. No matter what else you do, the lower you can get your ApoB, the longer you will go without a MACE.

Cool thing about a myocardial infarction is that the most common presentation is easy to spot. You'll be dead 1/3 of the time. The other 2/3 of the time you're guaranteed a life of exciting new medical interventions.

 

[Anonymous35]

Of course you're going to see a lot of patients in a hospital setting, especially heart disease patients, post cath lab patients, that are on both drugs because they're obviously not healthy being in the hospital so much more likely to be on both. This isn't representative of the general population though. I'd say maybe 25% of people on an ARB like Telmisartan are also on a beta blocker.

Probably more in france because betablocker are used a lot here
Its the most prescibed drug with atorvastatin here
(Bisoprolol)