Are all statins equivalent and interchangeable for everyone?

Question

Hi doctor,

Three years ago, I had a stent in my LAD, which had been 96% occluded. At that time, my cardiologist put me on Plavix for a year and ongoing 81 mg Aspirin therapy. I am also taking 50 mg of Atenolol. It was 25 mg until this month and was increased due to palpitations, probably stress-related. I was also put on 5 mg of Crestor a day. My doctor and I agreed to this since five men in my family took statins, and all had an adverse reaction. And, two of them were hospitalized due to it.

The therapy had been working, and my total cholesterol dropped from pre-stent therapy total of 219, HDL 140 mg/dL, HDL 44 mg/dL, triglycerides 209 mg/dL to post-stent with medicine total 138, LDL 71 mg/dL, HDL 39 mg/dL and triglycerides 141 mg/dL. Over the past year, I have been intermittently fasting. In the past year, I have further lowered my numbers to 91 mg/dL total cholesterol, 48 mg/dL LDL, 40 mg/dL HDL, and 61 mg/dL triglycerides. This latest result was repeated twice at six-month intervals. Now, my GP is skeptical about the low-dose statin and wants to put me back on a blood thinner as well. I cannot get in to see a cardiologist for a month.

I am reluctant to be put back on Plavix, and I am equally reluctant to change statins and increase the dose. The new GP has kept me where I am with medicines for now. What are my options? It appears that with my diet and current medical regimen, I am getting excellent results. Am I mistaken? Are high-dose statins required despite the good blood results? Are all statins created equal, and are they interchangeable for every individual? Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Good to know that you are in good control of your lipids. First of all, statins must be used when one has had a heart attack or stroke (disruption of blood flow to the brain). The dose of statin is set by the level of LDL (low-density lipoprotein). LDL must be lowered to one-half. In your case, Rosuvastatin 5 mg is doing the best. Yes, there are side effects of statins. The most common are muscle pain and weakness. In my opinion, Rosuvastatin 5 mg is the best for you because it is a low dose. If you change to another statin (Atorvastatin), you will have to take at least 40 mg per day, and that may cause side effects as these are common in your family.

So, I recommend continuing Rosuvastatin 5 mg. You may be thinking that I should quit statin as my lipid levels are quite under control. Remember, the good effects of statins in case of heart attack or stroke are not only through decreasing lipid levels but also many other ways statins benefit patients. So, keep up with your current treatment regimen. Keep your blood pressure under control and do regular moderate-intensity exercise for about 30 minutes a day for at least five days a week.

I hope this helps.

Please revert so I can assist you further.

Thank you.