Friday, October 19, 2012

LDL cholesterol , You can be less than perfect and still win

Diabetes is just a game of numbers.  

                   It is a game that allows you to be less than perfect and still win

I have a friend who shared his recent laboratory results with me . He has had a coronary bypass and was diagnosed with diabetes at the time of surgery. He currently is taking Lantus insulin ? dose, Novolog about once daily if his sugar is high before a meal, and Januvia. His glucose test result are higher than usual , he does not feel well and has lost weight without trying.
Lab test results
      FBS 321  mg/dl
      A1c 10.4
     Cholesterol 271       mg/dl
     LDL Cholesterol 160 mg/dl
     Triglycerides 383    mg/dl
      HDL  34
He does not like the idea of multiple injection and will be starting Bydureon if it is approved by his insurance company and his doctor doubled his dose of *Crestor.
He and his wife are concerned about his test results, especially the LDL of 160 mg/dl while taking Crestor.

Questions -

#1 Will doubling the dose of Crestor have a significant impact on his efforts to get his LDL cholesterol down to 70 mg/dl ? 

 Answer- doubling the does of Crestor will have minimal effect on his LDL cholesterol.
Have you heard of the rule of 7 ? 
Generally the initial dose of a "statin "will lower LDL cholesterol about 30 to 40 %  and doubling the statin dose will only add another 7 %. This makes it unlikely that he will reach his target goal of LDL  of 70 with Crestor alone. 

However he does not have to be perfect to win 
           He will  still have a significant benefit just by taking a "statin".

This was best demonstrated by the Heart Protection Study. This study was done using simvastatin ( Zocor ) in patients with known heart disease or elevated risk of heart disease

    In the study  40 mg of Zocor lowered the average LDL cholesterol by 42mg/dl ( 1.1 mm/l  ) and reduced the  rates of myocardial infarction, of stroke and coronary bypass surgery by about 25% regardless of age , sex or initial LDL level .  

 The CARDS study was done using Atorvastatin ( Lipitor ) 10 mg in people with type 2 diabetes with at least 1 risk factor for heart disease . Their average baseline  LDL was 129  mg/dl  and Lipitor 10 mg/day helped 75% of the study group achieve an LDL cholesterol of 93 mg% (2.4 mm/l) and 25% achieved LDL 's of 64 mg/dl (1.6 mm/L ).

 The people taking Lipitor benefited with   strokes reduced 48% , coronary Bypass graft  reduced 31% and acute Myocardial infarcts reduced 36%
 Just taking lipitor 10 mg/day Prevented 1 Cardiovascular event /37 pts./1000 treated for 4 years even though 75% of the people in the study failed to achieve the recomended target goal of 70 mg/DL (1.8 mm/L )

Good studies demonstrate that our friend will benefiting by just taking  Crestor . However he will  probable not gain much from doubling the dose  .

What else can he do?
Will controlling his blood sugars help control his abnormal lipid problem ?

This discussion will continue tomorrow.

Have fun , be smart , follow your doctors advise and take your Statin
David calder,MD

 commonly used "Statins"
atorvastatin (Lipitor )
simvastatin (Zocor)
rosuvastatin ( Crestor)
pravastatin ( Pravachol )
lovastatin  (mevacor )

When the data was corrected
           for other variables , zocor reduced the risk compared to controls  by about 1/3 rd. treatment for 5
           years will prevent 70 to 100/1000 from having a CV event

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Your comments and questions are appreciated. David Calder,MD