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Thursday, October 5, 2023

Statins and Side Effects,

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I am a 65 year old woman, smoker and hypertensive. I have been on telmisartan, nebivolol, and rosuvastatin/ezetimibe therapy for a year for high cholesterol and so-called “atherogenic” dyslipidemia. Total cholesterol is 136, HDL 62, LDL (on statin therapy) 64.2. The plaques have increased quite a bit, despite the fact that I quit smoking for about six months. Unfortunately, rosuvastatin/ezetimibe gives me muscle pain, which didn’t happen with a monacolin-based supplement of red yeast rice, phytosterols, fenugreek and linseed oil. Ggt (gamma-glutamyltransferase, a liver enzyme, ed.) has also increased. Should I change my therapy? Can Aspirin Help Control Plaques?

He answers Paul WerbaHead of the Department of Prevention of Atherosclerosis, Monzino Cardiology Center, Milan (GO TO THE FORUM)

There are several aspects to your question. In the first place the increase in plaques, which I assume is carotid artery. The evaluation of the volume of a carotid artery plaque with ultrasound-based methods it is not straightforward and it is possible that in later studies (particularly if performed by different operators or with different instruments) the results may differ, more due to differences in methods than due to an actual change in the size of the plate. In addition, the minimum time required to observe a significant change (improvement or deterioration) is generally quite long (years and not months). On the other hand, he did very well a stop smokingbut the plaque-level effects of cessation may not be felt for as little as six months.

Greeting muscle strain with rosuvastatin/ezetimibe, this happens in about one in ten patients taking these drugs, and there are strategies your doctor can take to address the problem (decrease dose, alternate day therapy, change statin), depending on your personal history (use of other compatible medicines, previous experience with other statins). They also exist innovative drugs to lower cholesterol which may be prescribed in some patients with statin intolerance. The aspirin should be used in primary prevention (people who have not had a stroke, angina pectoris, heart attack or other clinical manifestations of atherosclerosis), only when the plaques exceed a certain severity and there are no conditions that increase the risk of bleeding complications, primarily gastrointestinal or cerebral. In short, only your doctor can judge the cost/benefit ratio of aspirin treatment.

Source: Corriere

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