Q. From the reports, please tell me whether I am at risk of heart attack.

Hello doctor,

I am 41 years old, single, non-smoker, and I do not have any illnesses or physical symptoms. Just I have chronic anxiety and I take permanent medications for 10 years for that under health care which are Zoloft 100 mg along with Buspar 30 mg daily. I have made a checkup and ECG and everything is normal and I have no abnormal symptoms. I have attached complete blood tests to take look at it since my query related to this results. My weight is 231 lbs and the height is 5 feet 68 inches and note that the weight gain regarding side effects of constant medications especially Zoloft. The blood pressure is 140/82 and sometimes 150/90 and rarely became 159/110 as maximum reading. My questions now:

1. I scare and worry always about heart attack and clots because of the following indices: my platelets are always 450, blood pressure borderline or mild high always, lipid profile borderline always and CRP high always. what do you think, please?
2. To protect myself and encounter these risk early could I need regarding those values one of the following strategies. Note that I changed my lifestyle many times but no point because of the side effects of Zoloft and Buspar as weight gain.
3. Are you taking cholesterol-lowering medication like Lipitor (Atorvastatin)?
4. Are you taking blood pressure lowering medication like Cozaar (Losartan)?
5. Are you taking baby Aspirin daily as 81 mg?
6. Are you taking Metformin for encounter the weight gain resulting of Zoloft? And is it correct this medication can cause lactic acidosis poisonous by the time?
7. Are the medications Zoloft and Buspar the reason of those abnormal values of lipid profile and elevated of blood pressure? Please let me know what is the correct and best options regarding your experiences or do you have any other options?

Thank you doctor,

Kindly have a look at the attachments and advice.

Hello doctor,

I would like to get a practical consultation regarding your experiences and follow up on your previous consultation. I have tried to change my lifestyle, practice sports, lose weight, and diet using supplements for more than two years, but no changes in cholesterol and blood pressure results. Therefore I started with a low dose (Lipitor 10 mg), and after three weeks, the lipid profile was in the normal range and corrected.

I do not have any illnesses or physical symptoms except, as you know, I have chronic anxiety, GAD (generalized anxiety disorder), and SAD (seasonal affective disorder), and I have taken permanent medications for 12 years for that under healthcare which are Prozac 20 mg along with Buspar 30 mg daily. I have had a check-up and ECG (electrocardiography), and everything is normal and fine, and I have no abnormal symptoms. I attached complete blood tests to look at since my query related to these results. My weight is 224 lbs, and my height is 5.7 feet. Note the weight gain regarding the side effects of constant medications, especially SSRIs. The blood pressure is swinging between 140/90 mm of Hg, 145/100 mm of Hg, 150/90 mm of Hg, and 150/94 mm of Hg. The pulse rate is 70 beats per minute.

My questions are:

1) As you have seen, the cholesterol did not decrease until I started taking a low dose of Lipitor 10 mg, and I responded right and very well. So what do you think about this small dose? Can I keep it for the long term, and is it safe or dangerous? Is it better to make it 20 mg or keep 10 mg?

2) I fixed the lipid profile, but the blood pressure is still not in the normal range and is a bit elevated or mild hypertension, and I need to tune it to the satisfactory range. So do you recommend I start a low dose of Losartan? Can I return to normal values with the dose of Losartan 25 to 50 mg daily, and is it safe? Or can you suggest other types of medications to maintain blood pressure?

Thank you.

Hello doctor,

I use all of my medications after consultation with my doctors.

1) Is the following plan more rational and safer: (5 mg Lipitor and 40 mg Telmisartan) daily at bedtime?

2) Which is better due to fewer side effects of erectile dysfunction and weight gain: Telmisartan or Losartan? Which one do you prefer personally?

3) Are the blood tests normal?

Thank you.

Hello doctor,

As I have mentioned, I have started taking Lipitor 10 mg and gaining a good result in reducing the high lipid profiles to the normal range. Note that I still need to begin Telmisartan 40 mg to maintain and control blood pressure; I delayed this action a bit. But after a month of being on Lipitor 10 mg, I noticed too much erectile dysfunction (although it was before using Lipitor because of Prozac but not as much as after taking Lipitor. In addition, I have countered it by adding Wellbutrin to Prozac by my doctor). I became fragile and also had low libido after using 10 mg of Lipitor. My question now is:

1) Is this a new event or symptom because of using statin or Lipitor 10 mg daily?

2) Is all group statins as same as Lipitor due to erection and sexual side effect? Will switching to another type within the group might treat this problem?

3) I got medical advice to wean off Lipitor completely and start with Telmisartan 40 mg alone since Telmisartan has dual actions in reducing blood pressure and cholesterol simultaneously.

Do you agree about these tips if the Telmisartan is sufficient in reducing the LDL (low-density lipoprotein), as same as 10 mg Lipitor?

Regards.

Hello doctor,

Thank you for the reply.

Do you not recommend replacing Telmisartan with Lipitor? But personally, and regarding your experiences, do you prefer some statins over others for the few side effects of weight gain and other potential side effects? Do you recommend any medication agent to encounter weight gain?

Regards.