Posts Tagged ‘Lipitor’

By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music 

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By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

You  can lead a horse to water, but you can’t make him drink.  As Barret was talking about last week with stroke prevention, it can be difficult to convince people to take medications for chronic conditions.  If someone has high cholesterol now, they don’t feel bad.  High cholesterol doesn’t hurt.  So why should they take their cholesterol pills?

What is cholesterol?  Cholesterol is a naturally occurring substance in the body that is essential for life.  If you had no cholesterol in you, you would die. Cholesterol helps form bile acids in your digestive system, hormones in your endocrine system and important components of every cell membrane in your body.  Although cholesterol is essential for life, you don’t have to eat any.  Your liver can make all the cholesterol you need.

So why does your doctor test your blood for cholesterol if it is essential for life?  Why does your doctor care if your cholesterol is too high?  Well actually you doctor doesn’t really care about your cholesterol.  Your doctor is using cholesterol as a surrogate marker for heart attacks and strokes.  Heart attacks and strokes account for about one third of all the deaths inCanada.  That is more than any other disease. 

Your doctor knows that if you have high cholesterol you have a greater chance of having a heart attack or stroke.  How much greater chance?  Let’s look at an example.  Our patient is a 65 year old woman with Total Cholesterol of 6.2 mmol/L, HDL cholesterol of 0.9 mmol/L, and takes pills which keep her blood pressure at 140/75.  She doesn’t smoke and isn’t diabetic.  Her chance of having a heart attack or stroke in the next 10 years is greater than 30%.  She has about a 1 in 3 chance of having a heart attack or stroke.  She is considered a high risk patient.

So what can our patient do?  Diet and exercise are very important to prevent and treat heart attacks and strokes.  However, this patient already follows a good diet and gets a lot of exercise golfing and geo-caching.  So now what?  Well the primary target of cholesterol lowering therapy is something called LDL.  If LDL or bad cholesterol is high we have many, many studies saying high LDL increases the chances of the patient having a heart attack or stroke.  The most common LDL lowering medications are called the statins.  The statins stop the liver from making as much cholesterol.  The statins do a good job of reducing LDL.  We have lots of studies that show if we reduce someone’s LDL with statins we can reduce the chances of heart attacks and strokes by 25% to 35% with five years’ use

What does all this LDL, HDL, VLDL stuff mean?  When your liver makes cholesterol, it puts it into the blood stream.  Cholesterol is a kind of fat.  Since blood is mostly water, cholesterol doesn’t mix well with it.  The liver has to mix the cholesterol with proteins to get it to stay in the blood.  This mixture of cholesterol (which is a lipid or fat) and protein is called a lipoprotein.  If you take a blood sample and spin it really fast in a centrofuge, it separates based on density.  Different layers in the sample have different densities.  Low Density Lipoprotein or LDL is often called “bad” cholesterol because it transports cholesterol from the liver to places like the lining inside the arteries.  Through a complicated series of events, these cholesterol deposits can cause blockages that slow or stop blood flow.  If blood flow to the heart muscle is stopped, that is a heart attack.  If blood flow to the brain is stopped that is a stroke.  High Density Lipoprotein or HDL is called “good” cholesterol because it transports cholesterol  away from the cells lining the blood vessels.  This can decrease the chance of blockages.

Whenever we talk about putting people on a medication, they ask about side effects.  Statins are also generally well tolerated.  Statins can cause some stomach upset which can usually be fixed by taking them with food.  It seems that everyone is concerned that their statin will cause muscle pain or liver damage.  These are possible side effects but they are very rare.  If you get muscle pain all over on your statin, inform your doctor.  They will probably take you off your statin, and the muscle pain will resolve on its own.  As for liver damage, your doctor will do blood tests.  If there are signs of liver damage, again they will take you off of the statin and the liver damage will resolve.

The average patient who walks into the pharmacy weighs a few hundred pounds less than an average horse.  But I can’t stand beside a patient 24 hours a day and make them take their pills any more easily than I can force a horse to drink.  I just hope we can present the reasons why their cholesterol pills will improve their health and they will make the right choice.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

Heart Attack and Stroke Risk calculator: www.cvdriskcheck.com/FraminghamVSReynolds.aspx

For more info on Cholesterol Guideline visit:

www.ccs.ca/download/consensus_conference/consensus_conference_archives/2009_Dyslipidemia-Guidelines.pdf

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

We know now that in the early years of the twenty-first century this world was being watched closely by intelligences greater than man’s and yet as mortal as his own.  We know now that as human beings busied themselves about their various concerns they were scrutinized and studied, perhaps almost as narrowly as a man with a microscope might scrutinize the transient creatures that swarm and multiply in a drop of water.  With infinite complacency people went to and fro over the earth about their little affairs, serene in the assurance of their dominion over this small spinning fragment of solar driftwood which by chance or design man has inherited out of the dark mystery of time and space.  Yet across an immense, ethereal gulf, minds that are to our minds as ours are to the beasts in the jungle, intellects vast and cool and unsympathetic, regarded this earth with envious eyes, and slowly and surely drew their plans against us.  And in the eleventh year of the twenty first century came the great disillusionment.

So are you scared yet?  In a world of Saw 4, Scary Movie 4, Insidious, and Paranormal Activity a radio play about a Martian Invasion is unlikely to cause mass hysteria.  Our grade 4 teacher played our class a record (yes, a record) of the Orson Welle’s 1938 radio play of “War of the Worlds”.   I remember being surprised to hear that this radio play fooled people into thinking that the Martians were attacking.  The reported riots after War of the Worlds completely baffled me because Orson Welle’s alien invasion had nothing on the aliens from the X-Files.

A gentleman came into the pharmacy with a clipping of a column from the Winnipeg Free Press.  It was written by a medical doctor. The column claimed lipitor or atorvastatin was unsafe and there was a better herbal treatment called Sytrinol.  Atorvastatin or lipitor is a cholesterol lowering medication.  The group of medications that include atorvastatin are called statins.  The article’s opening line was “Prescription drugs can kill, natural remedies rarely”.  That sort of hyperbole can be dangerous.  The gentleman who brought me the clipping was wondering if he should take his elderly relative off of atorvastatin and put them on the herbal product Sytrinol instead.

The Winnipeg Free Press column focused on the side effects of atorvastatin and didn’t mention the benefits at all.  As the column said medications like atorvastatin can cause nerve damage and muscle damage.   These are possible side effects of statins but they are very rare.  Muscle pains in people taking statin can occur in approximately 5% of patients, although similar rates are often seen in the placebo groups in clinical trials.  That means up to 5% of people taking the sugar pills also complained of muscle pain.  Nerve damage is even more rare.  I’m not trying to minimize that side effects like muscle pain can happen on statin medications.  Statins can make your muscles sore and we don’t want that.  But I don’t want everyone with sore muscles on statins to throw the statins out the window without talking to their doctor first.  That is because statins do good things too.

The benefit of statin drugs like atorvastatin is they reduce heart attacks and strokes.  We know that for every 1.0 mmol/L we lower LDL or bad cholesterol with a statin we reduce the chance of a heart attack or fatal heart problem by 20-25%.  This was published by Baigent et al in the Lancet in 2005.  This group looked at 14 statin studies which means they were looking at a group of 90,056 patients.  The alternative to statins proposed in the Free Press article is called Sytrinol.  It contains citrus and palm fruit extracts.  The writer in the Free Press says several studies say it reduces LDL by 30%.  So I looked up the studies.  The first two studies had 10 people in them each.  The third had 120 people in it.  So we are comparing a herbal product tested on 140 people to a prescription medication tested on over 90,000 people.  That makes the evidence for atorvastatin much more convincing.

Statins like atorvastatin are powerful drugs and should be used with respect.  All medications have side effects and they should be dealt with if they appear.  However implying that atorvastatin is unsafe and that the herbal product Sytrinol is better at protecting the heart is just plain wrong.  Atorvastatin is well tolerated by most people and has been shown to reduce heart attacks and strokes.  Saying Sytrinol is a better choice is like saying War of the Worlds is a documentary about an actual alien invasion.  Don’t fall for the hype.  As Mulder and Scully would say, “The Truth is Out There.”

Free Press Article  http://www.winnipegfreepress.com/arts-and-life/life/health/natural-medicine-best-for-lowering-cholesterol-118226289.html

War of the Worlds Radio show http://www.youtube.com/watch?v=egudvdwtDIg

Lipitor Monograph http://www.pfizer.ca/en/our_products/products/monograph/127

Cholesterol Guidline’s visit:

www.ccs.ca/download/consensus_conference/consensus_conference_archives/2009_Dyslipidemia-Guidelines.pdf

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only.  It is not intended to be used as a substitute for professional advice.  If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website.  Please visit us at www.dcp.ca

By Trevor Shewfelt.  Recorded by the nice people at 730 CKDM, The Parkland’s Best Music

Audio clip: Adobe Flash Player (version 9 or above) is required to play this audio clip. Download the latest version here. You also need to have JavaScript enabled in your browser.