My father is 76 years old. He has been a type 2 diabetic for close to 40 years. He had also been a smoker for over 40 years before finally quitting 13 years ago. He has been able to control his blood sugar quite well throughout the years. He has never had a heart attack, or experienced any chest pains. Nevertheless, he did undergo triple bypass surgery 10 years ago after a routine stress test showed blockages. He had been taking 40mg Zocor for a number of years, but quit taking it about three years ago because of side-effects, which included neuropathy. Of course, his cardiologist never felt that Zocor was the cause of all the pain and discomfort, but he accepted his decision to discontinue the drug. Of course his cholesterol went up after that, but I hardly think his numbers are terrible.

In the meantime, my father has been seeing another doctor for chelation therapy treatments. He visited this doctor today, and brought along with him the results of his recent blood test. His total cholesterol was 233, with an HDL of 75, LDL of 146, and the triglycerides were 62. I think that overall these numbers are pretty good. He is not taking any cholesterol medication. He does take Glipizide for blood sugar, Enalapril for blood pressure, and also something called Coreg and Sular. He also takes quite a few supplements, such as vitamin E, vitamin C, coenzyme Q10, fish oil, selenium, inositol hexanicotinate (flush-free niacin), magnesium, lysine, marine beta-carotene, B-complex, etc.

Anyway, after seeing my father's recent blood test results, he suggested that he start taking statins again! I couldn't believe it when my father told me that. Not only that, but he wants him to take 80mg Lipitor! I think this doctor is caught up in this latest LDL craze, since he said his LDL should be under 70! I just don't buy this nonsense, especially when you're dealing with a 76 year old person who already had problems with 40mg Zocor. Of course, I doubt that my father would even consider doing this. But the mere suggestion of something so absurd is enough to make be question the judgement of many doctors. So what's going on here? Am I nuts, or are some of these doctors literally going out of their minds?

My goodness, a TRIPLE BYPASS without having had any chest pain...gee, that seems like massive overkill! Wasn't he a good candidate for angioplasty?

How is he leaning vis-a-vie the statin dosing?

Has he had an angiogram in the last 5 years? I'm always fond of diagnosing BEFORE treatment...I know this strains medical brains and actually takes some effort.
I'd base my estimate of his need for statins on whether or not the condition of his arteries has deteriorated much in the last 10 years. If so, I'd say go agressive with statins; if not, NOT!

In the same vein, shouldn't some sort of the same check be done before and after chelation be done to assess whether anyone but the doctor gets any benefit. (What is the going rate for intravenous chelation these days?)

Good Luck the old guy! :D

Well, at the time he had the bypass surgery he was told that he was not a candidate for angioplasty. As far as I know, the only angiogram he had was prior to the surgery. He did have surgery on his right carotid artery a year after the bypass. He does see his regular cardiologist every three months. He also gets EKGs and echocardiograms done every year. He also visits a vascular surgeon who checks his carotid arteries every year or so.

As for chelation, he is currently on a maintenance program and receives one treatment per month. I believe it costs $100 per treatment, but he must pay the full cost. Unfortunately Medicare won't cover that. The doctor who administers the treatments said that although chelation may not always remove plaque, it does tend to stabilize it. That's what they think, anyway. Is it doing him any good? I really can't say. I have no way of knowing.

As far as statins are concerned, I don't think he has any intention of taking them again after what he went through on Zocor. And I tend to agree, especially for a person his age. He already has his share of aches and pains without statins. But what really floored me was when that doctor recommended an 80mg dose of Lipitor! Eighty milligrams for a 76 year old man? That's insane. That wouldn't help him. If anything, it would probably kill him. I think it's best that he just sticks with the supplements he is currently taking.

Arizona, your dad's current numbers sound fine! In fact, his numbers aren't that much different than mine, though I'm a 55 year old female.

In another thread I discussed statin (Lipitor) usage and mentioned the eventual outcome of my dilemma, since my cardiologist was at odds with my internist. Internist said "take Lipitor now!" and cardiologist said "your ratios are fine -- but if you REALLY want to know if there's any build-up -- go get the heart scan to look for calcium in heart arteries."

So... I went to Cedars-Sinai's state of the art facility in L.A., took the 10 minute, non-invasive test, paid my $400 (yes, it's expensive and not covered by insurance), and found out I have ZERO calcium in those arteries despite elevated LDL and total cholesterol levels. My recent numbers were something like: 240 total, 153 LDL, 65 Trigs, and 93 HDL. The trigs and HDL were clearly excellent and the total and LDL not so good.

If your dad really doesn't want to take a statin, and can afford this scan, I'd say he should do THAT and save himself the aggravation of the pills unless it's found to be absolutely necessary to take them.

At Cedars they had me fill out a questionnaire, then they drew blood (I had fasted overnight per their request), then I had the scan, and then their "Director, Nuclear Cardiology/Cardiac Imaging, Professor of Medicine, UCLA" looked over the results and went over the "score" with me. Within an hour I knew everything I needed to know and was happy as a clam after being told by the doctor, who was LAUGHING, "No, you DON'T need to take Lipitor!"

Even I HAD had calcium build-up, I would've been satisifed with the test and would probably be on Lipitor now, but taking it just because a couple of chol. numbers aren't perfect without knowing the whole situation seems like overkill to me.

Good luck to your dad!!!!!

Thank you for the reply, cheer up! I really appreciate it. You know, all things considered, I think my father has done pretty well over the years, considering the fact that he had smoked for over 40 years, and has been diabetic since 1965. I also agree that his numbers are pretty good, and that many people half his age would be happy to have numbers like that. That's why I could not understand why that doctor would recommend that a person his age should start taking 80mg Lipitor! It just doesn't make any sense. There are so many other people with much worse lipid profiles who are only taking a fraction of that amount. I just want my father to enjoy his remaining years without enduring more problems than he already has. And I don't want any doctor overdosing him with dangerous drugs. At his age, something like that may put him in a wheelchair, or worse, and I certainly don't want that to happen. I know what the potential dangers of these drugs are, especially among older people, and I certainly would not want to subject my father to such a risk.

That's why I could not understand why that doctor would recommend that a person his age should start taking 80mg Lipitor! It just doesn't make any sense. There are so many other people with much worse lipid profiles who are only taking a fraction of that amount.

I appreciate your distaste for statins, but I'll try to answer your question as posed, assuming it's not rhetorical.
Your dad's doctor looks at his risk profile. That profile shows an elderly man who has proven heart disease as evidenced by a triple bypass operation a decade ago who was a long-term smoker and is suffering from diabetes and hypertension who exhibits high cholesterol.
I doubt that the doctor has run into any patient who has more risk factors for death from heart attack in the last month than your father. I don't think there ARE any other risk factors short of working in a coal mine!:D

The doctor feels, with some legitimacy, that he must take the strongest action to curb any further risks. To him that means getting cholesterol as low as humanly possible. He reasons that avoiding ONE heart attack will give your father several more years of life and he follows the guidlines. His reasoning is sound.

The conditions that you mention mitigating against the 80 mg. Lipitor are the discomfort that your father suffered from earlier statin use and his age.

Your father, with your aid and his doctors, must strike a balance between these needs. Perhaps lower stating dose...10 mg. Lipitor? Perhaps the mixed esetimibe/statin? But some choice must be made. His doctor feels that assuming 233 is just fine and dandy is the wrong choice...I agree. Perhaps if he (and you) feel that the chelation really WILL keep the arteries clean, then maybe twice a month or more might be a sensible choice.

I think an angiogram is a wise choice for him at this point (I know, I know...discomfort.) But any choice is best made with maximum information...who knows, maybe his arteries are CLEAN!:D

An aside: my dearest friend is 77 and he runs four times a week (even in this cold) and has taken 40 mg. simvastatin daily for 4 years. He can go to movies and theater 7 nights a week and still works part time. So age 76 isn't too old for agressive treatment.

Lenin,

Thanks for your reply.

If your friend is still able to jog at age 77, then he is by far the exception to the rule, an anomaly of sorts. Most people that age have enough trouble just walking.

Anyway, there are differences of opinion, even among doctors, about prescribing statins to people in their 70s and older. Some feel that there really isn't any benefit for people in that age group. But even if there was, there are still individual concerns, such as the person's overall state of health, the risks involved, and any adverse consequences on their quality of life. Your friend is very fortunate to be able to do the things he does, but he is the exception. Most people that age, my father included, have other problems such as arthritis, which hamper their mobility and overall state of well-being. In such cases, there is the very real danger of adding even more fuel to the fire. Quality of life eventually becomes more important than quantity of life.

I may not have mentioned it, but my father's primary physician, a cardiologist, is not the doctor who urged him to go back on statins. It was another doctor he goes to for chelation treatments.

The CHELATION doctor told bim to go back on statins!!:eek: My God, that's quite a testimonial to that doctor's integrity.

Yeah, my friend AMAZES me. He can waken bent over with a crooked lower spine and he says: "A good run will straighten this out," and it bleedin' well DOES! Many people would seek out an easy chair instead.


I really don't think, though, there is much medical dissent about statin use for seventh decade diabetic ex-smokers with heart disease and high cholesterol. Truly I don't.
With a healthy person exhibiting only bad lipids at 76...another story entirely.

Yes, this particular doctor surprised me as well. When I first learned about him, I was under the impression that he was more of a complimentary physician rather than mainstream. I found out that he administered chelation therapy, and was located only a short distance from where we live. So I suggested to my father to give chelation a try. Anyway, sometimes I would accompany my father when he goes for the treatments, so I have spoken to this doctor on numerous occassions. It really struck me that he appeared much more mainstream than I thought, and I would sometimes quibble with him about statins. As you know, I am by no means a big fan of statins, but evidently he is, although he does encourage the use of other supplements as well. AND, he does have a sign clearly posted in his office advising patients who are taking statins to supplement with coenzyme Q10. I also saw him being interviewed on television one day about chelation therapy. In fact, he is involved in conducting a study on the effects of chelation, and is currently seeking volunteers. I also heard him say that although he administers chelation treatments, his practice is primarily that of a mainstream physician. He admits that the combination is somewhat "schizophrenic".

I think if your father is doing well at age 76 by doing the things he has been doing and is feeling fine then why upset the apple cart? I think the decision should be left up to him as to what he wants to do as far as the Liptor is concerned.

I have been on Lipitor 10mg for almost 2 months now and I have had no side effects from it as of yet. I'm 49 and my I didn't think my levels were all that high but the doctor insisted I go on it. My cholesterol was 229, Trig. 140, HDL 140, LDL 160. The Chol/HDL ratio was 5.7

I had lab work done on 12/23/04 but I don't know the results yet. I will know them on Monday. The only thing the doctor told me was abnormal with my lab test was the Renin/Aldosterone test he did. My renin level was high (6.64) and the aldosterone level was low (5.2) He was looking to see if I had Primary Hyperaldosteronism.

I'm not a doctor but I think 80mg of Lipitor is a lot. I work in a group home for Developmentally Disabled and quite a few of the elderly patients there have high cholesterol worse than your father's and they are only on 10mg of Lipitor and it seems to be working because their levels have improved.

I would research this further if it were my father and possibly get a second opinion before I let the doctor start him on 80mg. I think it's a little extreme. Why doesn't the doctor start him on 10mg if he really thinks he needs it?

Dianne

My cholesterol was 229, Trig. 140, HDL 140, LDL 160. The Chol/HDL ratio was 5.7

That doesn't compute. Did you make a typo in recording these numbers? Did you, by chance, mean HDL was 40, not 140?

Sorry.....it was a typing error. It should be 40. Sometimes I type too fast.

Dianne

dianne,

Just for grins I'm going to hazard a guess on your Lipitor labs:

Old:
TC: 229
LDL: 160
HDL: 40
TRIG:140

My guess on the new:
TC: 170
LDL: 100
HDL: 48
TRIG: 110
(I THINK that adds up!)

Anybody else want to venture a guess.

Dianne,

I agree that 80mg Lipitor is excessive, especially for someone who is 76 years old. I personally do not feel that it would be in my father's best interest to go back on statins, nor do I think that his numbers justify it. Diabetic or not, I don't think his numbers are anything to be alarmed about. Quite the contrary. When you take into consideration the low triglycerides and the high HDL, the odds are that his LDL is primarily Pattern A. His triglyceride/HDL ratio is a respectable 0.83. I don't think you can get much better than that. Of course, if the situation was reversed, and the ratio was high, well then I would pay more attention to the LDL.

In addition, my father's homocysteine level falls within the normal range, at 8.27. When he had his CRP checked, it was only 0.68. So all in all, I think he's doing fine, and no, I don't think he'll go back to taking statins again.

Lenin,

I will get the results of all my lab work tomorrow when I go to the doctor. It will be interesting to see how the lab levels will compare to yours. Now for a good question....how do I go about getting Renin levels lower? As of 12/29/04 my renin level was 6.64 Is this something I can do or is it something that medications and the doctors do? My aldosterone level was 5.32 which falls into the normal range but is on the low side of normal.

Arizona73,

I agree that if your father is doing well at 76 and is happy then leave him alone. He sounds like he knows what he's doing and it's working for him. We all should be as lucky as him to survive all he's been through and is still able to do for himself at 76. Let him enjoy his life. He worked hard to get to where he is.

Dianne

dianne,
That discussion is running strong on your other post but let me add another thought. Your renin is only slightly abnormal (normal is 1-6 by one standard I saw.)
A high renin value can indicate kidney disease, blockage of an artery leading to a kidney, Addison's disease, cirrhosis, excessive bleeding (hemorrhage), or malignant high blood pressure.

But I really think your slight elevation above normal was caused by the Cozaar.

Lenin,

My Cardiologist did not agree that my levels were only slightly above normal. He said they were 3x's the normal lab limits. I guess each lab has their own standards. He also said that Cozaar will raise the levels but not that much.

The Hematologist I go to for my anemia called me last night and he is concerned about the renin level also. It will be interesting to see what the kidney doctor has to say next month.

Thanks for your information. I appreciate it and it did help ease my mind because I really don't want anything to be wrong with my kidneys. I'd rather someone tell me something different than what the doctors tell me because then I know what questions to ask the next time I go to the office.

Dianne

Good morning Dianne,
Here's a great article from Medscape discussing the renin/aldosterone system...the R versus V hypertension. It may take a couple reads but it's well worth the time.http://www.medscape.com/viewarticle/466010_print

Olsen,

Yes, I believe you're right about that. As a matter of fact, I've heard that higher cholesterol levels in the elderly correlate more strongly with decreased overall mortality. Of course, having said that, I'm sure someone will likely respond with contradictory information. :dizzy:

So ARIZONA,
What choice has your father made?

Lenin,

My father doesn't appear to be interested in taking statins anymore, and I don't blame him. He is 76 years old now, and has had problems with Zocor in the past. He is currently taking about four different medications for his high blood pressure and diabetes, and he has more than his share of aches and pains, such as osteoporosis and arthritis. On top of that, my mother is also ailing (possibly spinal stenosis, but we'll find out for sure when she has an MRI on Tuesday). So, as you can see, it is not a very happy atmosphere, and I am beginning to become quite depressed about my parents situation. It's not easy watching your own parents grow old and miserable. I wish I can do something, and I wish the doctors can do something. But I'm afraid there comes a point in time when there really isn't much anyone can do anymore. That's the worst part. They're all I've really got, and the feeling is that of total helplessness.