Statins After Stent

Getting a stent is sometimes a patient's first encounter with coronary artery disease. A standard regimen of prescription medicines is usually given to control blood pressure, cholesterol, etc. and lower the risk factors for future progression of disease. But some patients have adverse reactions to some of these medicines, statins being one of them. Post comments or questions about statins, adverse effects, etc. here.

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Current Postings on This Page (11):

• To all Forum users - Yesterday the AHA/ACC released new guidelines for the treatment of cholesterol. And they are a big shift from the previous treatment guidelines. No longer are target numbers for cholesterol the goal. Instead patients are being looked at in terms of their risk factors, and those with the highest risk of heart disease will be treated most aggressively, but with statins, not other cholesterol-lowering drugs like Ezetimibe/Zetia (which several of you have written in about). The reasoning is that statins have benefits beyond just lowering numbers, and that just lowering numbers has never been proven to reduce risk of cardiovascular events. The idea of treating risk and not target numbers has long been advocated by Drs. Hayward and Krumholz of Yale (read their January 28, 2012 letter in "Circulation: Cardiovascular Quality and Outcomes") and that position is now central to the guidelines. However, a big question is what to do for patients who cannot tolerate statins (again, as many of you have written in about)? Should they be given non-statin cholesterol-lowering meds such as Zetia? And how many patients really are unable to tolerate statins. We believe that, like many adverse reactions and event in medicine, this number is under-reported. With this new increased population of patients tking statins, we may be about to find out!
Angioplasty.Org Staff, Angioplasty.Org, November 13, 2013

• RE: My husband's mother has very high cholesterol and high triglycerides, however she takes Lipitor but no CAD or other related issues such as stroke....she is 77 and has never had any cardiovascular issues His other familial history is difficult to ascertain as his grandfather (maternal) and uncle (maternal) both died from heart attacks at age 62 over 40 years ago He is willing to take statins but due to the severe muscle pain, weakness and elevated enzymes has been pulled off three times, His cardiologist that performed the stent started him on Zetia and they are looking at other options. This is frustrating for him as he is doing everything he can and always has to avoid CAD. His cholesterol level as of three weeks ago prior to stent procedure was total 246 HDL was 44, LDL was 168 and triglycerides were 180. He had been taken off all meds due to liver enzymes and is now on 10mg Zetia. As mentioned previously he is not against taking the statins but even Simvastatin and Pravastatin at very low doses caused him serious side effects.
Suzanne, Rhode Island, USA, July 11, 2013

• Suzanne in Rhode Island - How is your husband's cholesterol level? We're assuming your husband has not been diagnosed with familial hypercholesterolemia. Assuming so, the Zetia, plus his diet and exercise, may be enough to keep his cholesterol levels in check. Although there's nothing we can do to change our genes (yet anyway), we are able to reduce those risk factors that are modifiable, high cholesterol being one. The Plavix and aspirin are for keeping the blood from clotting in the stent. The ACE inhibitor and lopressor for control of blood pressure. BTW, recent studies have shown no cardiac benefit for Niacin.
Angioplasty.Org Staff, Angioplasty.Org, July 10, 2013

• My husband age 54 with a family (grandparents, uncles) hx of CAD recently underwent a stent procedure in the LAD central branch. He has always been careful about diet, is a runner 4 miles approx 3-4 times a week for over 25 years, cyclist and attempted to take statins. He is one of the small percentage that cannot tolerate statins, has tried 3 Statins Did Niacin for 3plus years until liver enzymes became quite elevated. Is now on Zetia which appears to show only partial help. What other therapies remain, he is currently on Lopressor, Plavix, Aspirin, Ace inhibitor, and the Zetia. He did very well with the stent procedure and does not want his CAD to progress.
Suzanne, Rhode Island, USA, July 10, 2013

• JC in Houston -- Looking at your story, we'd have to say that your husband's cardiologist is giving him what seems to be advice born out by experience, unfortunately not good experience in your husband's case. Part of "optimal medical therapy," besides just the drugs, is reduction of all modifiable risk factors. These would include diet, weight control, eating healthy food (see Mediterranean diet), certainly stopping smoking (which we assume he has done) and exercise -- not necessarily vigorous workouts, but even just regular and long walks are very helpful. Lipitor is a statin which lowers cholesterol but also has other benefits in terms of endothelial health (lining of the artery). Effient (and Plavix) are antiplatelet drugs, which keep the blood from clotting and forming a thrombus which leads to a heart attack. Normally these drugs (plus aspirin) are prescribed for one year plus aspirin for life. In your husband's case, his doctor is using your husband's negative experiences to recommend Effient and Lipitor for life as well. Stents can keep a blockage open, but they are not a cure for coronary artery disease, which is essentially a biological problem.
Angioplasty.Org Staff, Angioplasty.Org, March 26, 2013

• My husband has had 3 heart attacks. He has 3 stents. His first heart attack was in 2005 and two stents were placed. At that time he was put on Lipitor and Plavix. He had high cholesterol and was a smoker. In 2007 he had another blockage (not a heart attack) put another stent in. In 2010 in a routine blood work found low white blood count, neutrapina. The cardiologist and Hematologist/oncologist decided to take him off lipitor and Plavix to see if his white count would go back up. Within a week he had a heart attack. They found that one of the original stents put in, in 2005 had closed. They told him never to get off Plavix again. After that the doctors put him back on lipitor and Plavix but switches his Plavix to Effient (a new blood thinner) they could never find out why his white blood count was so low. The did two bone marrow biopsies and both times came back negative. At this point, my husband and I decide to go behind the doctors back and consulate a Chinese medicine doctor. She was going to help my husband slowly get off lipitor and Plavix and replace them with herbs. We started the herbs in march of 2011. He stayed on his prescription medication at the same time he started on the following herbs: cordyceps, circulation P, Puerarin and Copmine. His white count went up eventually in range. After several weeks she cut down a Lipitor and then an Effient...til after 18months he was only taking one lipitor a week and 4 Effients a week. At the 18month mark, he has another major heart attack. This time he had gone in to cardiac shock, he sustained muscle damage this time. He was on an aortic pump for 4 days also. This time, the original two stents that were placed in 2005 had closed up again. The cardiologist said don't EVER EVER stop lipitor or Effient again. He said he will have to be on them for the rest of his life because of those stents. Is this true? are these stents going to require him to be on those two drugs for the rest of his life?
jc, Houston, Texas, USA, March 24, 2013

• Hi. I had 3 cardiac stents fitted/ unnecessary as confirmed by review at major heart hospital. The reason for my response is that I was placed on 40mg of Lipitor for slightly elevated Cholesterol, then after 2 months increased to 40mg of Crestor for nearly 5 months. Woke at midnight with horrific pains throughout my muscles. I think all medical professionals should prescribe COQ10 with Statins to stop the damage to the muscles. Do your research on this topic. I myself have proved the benefit of them and have introduced them to many friends on statin drugs.
John Australia, Queensland, Australia, December 3, 2012

• H in Saudi Arabia -- A 2010 study from Japan, "Effects of three strong statins (atorvastatin, pitavastatin, and rosuvastatin) on serum uric acid levels in dyslipidemic patients," showed that Crestor (rosuvastatin) decreased uric acid level, but not as much as Lipitor (atorvastatin). Interestingly Livalo (pitavastatin) actually increased uric acid levels. Since high uric acid levels are considered a risk factor for heart disease, the lowering of these levels is desirable.
Angioplasty.Org Staff, Angioplasty.Org, July 19, 2012

• Hi, Does statins like Crestor increases uric acid levels? and if uric acid is elevated is it a sign of something to worry?
H, Kingdom of Saudi Arabia, July 16, 2012

• Wes in Wisconsin -- Thanks for your post and for starting this new topic. You certainly are not alone. We have received a number of posts over the years from patients who have difficulty tolerating statins. Sometimes it's to a particular statin, but often it's a class effect. While statins can be very beneficial to some, if you are able to control your cholesterol without them, you have to look at the risk/benefit ration of whether the benefit you may receive is outweighed by the adverse reactions. In fact a January 28 open letter by Drs. Hayward and Krumholz of Yale appearing in "Circulation: Cardiovascular Quality and Outcomes" questions the LDL target itself. That being said, we do not give medical advice and urge you to discuss this further with your cardiologist, although it sounds like you are already in communication and working together in a "therapeutic partnership", which is the goal.
Angioplasty.Org Staff, Angioplasty.Org, February 16, 2012

• Soon after receiving stents in my heart arteries I began experiencing severe neck and back pain that radiated into my left arm and chest, mimicking heart attack symptoms. Several tests showed no heart problems. The pain was crippling. I went to see my primary physician who decided that it might be statin-induced muscle pain. After reducing the Lipitor from 80mg to 40mg, the pain was diminished, but still terrible. After testing, he lowered the dose to 10mg, and again, the pain lessened. While better, it is still intense.

I have read studies that claim statins have more effects than simply lowering cholesterol-- that they help to heal the endothelium and help stents to embed with fewer complications. I have also read studies that claim the opposite -- that the beneficial effects come about only because cholesterol has been lowered.

If my cholesterol/triglyceride numbers are low enough without Lipitor, will I be putting myself at risk if I stop taking it? My total cholesterol=85, ratio=2.8 and trigs=82. My primary found that incredibly low. To me it sounds like I have enough wiggle room if I stop Lipitor, and the numbers go up a bit. Any thoughts will be appreciated.
Wes, Wisconsin, USA, February 16, 2012

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