• Archives

  • Dec2

    Statins on Sale: Is Generic Lipitor a Bargain?

    Posted in: High Cholesterol, Vitamins and Supplements, Wellness and Health

    The most popular Rx’d drug in America, Lipitor, went generic this week as atorvastatin. Lipitor sales were $8.7 billion last year, and 3.3 million people take it. If you have insurance, request the generic. Watch your copayment drop from $25 per month to a generic copayment to $10.

    If you don’t have insurance and pay out-of-pocket, your cost will go from ~$150 a month to maybe $15, in about 6 months.

    But is Lipitor a bargain at 90% off? Yes and no.

    Yes: if you have diagnosed heart disease, statins prevent one death for every 48 patients treated for 3 to 5 years. I recommend them.

    No: if you don’t have heart disease, statins taken daily, as directed, prevent one heart attack (a nonfatal one) for every 60 patients treated for 4 years.  Because the reason to improve cholesterol is to prevent heart attack and death from heart disease.

    Statins do cause many extra costs: liver testing every 3 months, worries about calf and thigh pain and myopathy, and for a few unfortunates, rhabdomyolysis: basically, liquid muscles and kidney failure.  Lipitor especially interacts with beer, wine, chapparal, comfrey, grapefruit and St. Johns wort.  And antifungal meds, calcium channel blockers, cyclosporine, niacin, fibrates and digoxin.

    What could you do instead?

    You could take an effective dietary supplement, like Cholest-Off or Benecol Smart Chews (Caramel). You could read about lowering cholesterolt in Controlling Cholesterol for Dummies, or learn what the Wall Street Journal and New York Times advise, highlighted on this blog.  You could discover other ways to save on prescription drugs.

    Maybe smartest of all, you could check your own cholesterol, at home, with CardioChek…minimizing statins and taking control of your own health.  Because you are your own best investment.

     

  • Aug9

    Do Statins Raise Diabetes Risk?

    Posted in: Aging and Costs of Aging, Diabetes, High Cholesterol, Vitamins and Supplements, Wellness and Health

    Probably, in higher doses.

    A study of 18000 people without heart disease, called JUPITER, shows that Crestor (rosuvastatin) 20 mg showed that for every 1000 patients on high dose (40mg and up) statins, there are 6 more cases of new diabetes over 2 years.

    Crestor also prevented 11 cases of heart attack, stroke, arterial revascularization, hospitalization or death from heart disease, in that 1000 patients.

    The newest study includes 32,752 patients without heart disease.  Again, 2 cases of diabetes, versus 6 or more cardiac events prevented in a 1000 people over 5 years.

    If you actually have heart disease or angina, then the numbers for taking a statin are different.

    • 1 in 83 life saved
    • 1 in 39 prevented a non-fatal heart attack
    • 1 in 125 prevented stroke
    • 1 in 167 developed diabetes

    Is that worth the trade-off?

    I try to find ways for my own patients to get off high doses of statins, especially 80mg doses, because of myopathy and pain.

    A cholesterol registry can chronicle how people control cholesterol naturally.

    I suggest that any patient 40 and over get screened every 3 years, and make sure they don’t suffer from abnormal lab test syndrome.  And I help them make lifestyle changes that help them reduce their need for cholesterol medication.

    Statins can be important medications, and their benefits can be greater in diabetics than nondiabetics.

    But there’s no sense in tempting fate. Let’s enjoy life, and avoid getting diabetes in the first place. Lower your cholesterol with what you eat.

     

  • May31

    Food Lowers Cholesterol: New Studies

    Posted in: Aging and Costs of Aging, Food FAQ's, High Cholesterol, Vitamins and Supplements, Wellness and Health

    Wayward cholesterol levels are some of the easiest labs to treat with the right foods: I help my patients do it here in the office, have taped ChefMD videoblogs and spoken with journalists about it.

    And the research continues to mount.

    Last week, an Australian meta-analysis of 14 studies showed that, on average, the equivalent of 5 ounces of tomato sauce (25 milligrams of lycopene) or 2.5 ounces of tomato paste (ditto) lowered LDL cholesterol as much as small doses of statins–about 10%.

    Lycopene from tomatoes is 4x better absorbed if the tomatoes are cooked, and eaten with a drop of luscious oil, btw. Thus, sauce and paste.

    Two other studies which Katherine Hobson highlighted last week in the Wall Street Journal suggest that medication for this purpose, well, may not be all it is cracked up to be.

    One found that extended release niacin (Niaspan, a form of vitamin B3, available only by Rx for raising HDL) didn’t protect against heart attacks when added to statins.

    The other found that a fibrate called Tricor, also by Rx, didn’t prevent heart attacks and strokes, also when added to a statin.

    These are, individually, multi-billion dollar drugs.

    Studies like these make me think there should be a cholesterol registry– a place where the best natural approaches to lowering cholesterol can shine.

     

  • Mar23

    Statins, Leg Pain and Cholesterol: Foodie Alternatives

    Posted in: Common Conditions, High Cholesterol, Wellness and Health

    The March 19 2010FDA Warning about Zocor, a statin medication causing myopathy, and rare rhabdomyolysis, makes me think about other ways people who love food can lower their cholesterol too.

    The simple story is this: eating food with cholesterol in it doesn’t raise your cholesterol level, very much. It’s foods (red meat, cheese) with solid fats (saturated and trans) and for some people, highly processed foods with starches and sugars.

    The NY Times’ Tara Parker Pope‘s smart “Eating Your Way to Lower Cholesterol” has great tips (see #24 and #61) as does the WSJ’s Tom Burton’s now famous “A Reporter Eats His Way to Lower Cholesterol.”

    The foodie story? Foods rich in soluble fiber (barley, oats, beans, lentils) lower LDL cholesterol: up to 50 grams daily has an effect: beyond that, not.
    Flax meal has an important effect: up to 2 tablespoons twice daily. Omega-3 fatty acids raise HDL (healthy cholesterol), as does alcohol–one drink for women, and two for men.

    Eat an ounce and a half of nuts daily instead of carbs like crackers/chips. Try stanol/sterol margarines instead of butter and sour cream. Add green or black tea. Consider cinnamon.

    In the supplement world, look at lecithin and psyllium.

    None of these cause leg pain, cost hundreds of dollars per month, or necessitate remembering to take your pills. And they can taste much better!

     

  • Aug4

    A Reporter Eats His Way to Lower Cholesterol: Do You Need Lipitor, or Can You Do It With Food?

    Posted in: High Cholesterol, Vitamins and Supplements

    The New England Journal of Medicine reportthat Lipitor beat Pravachol in cholesterol-lowering for patients is one thing. Using food to lower cholesterol is an additional, not alternative approach.

    Will the 80 mg cost $276 U.S. for 90 days from drugstore.com or will it cost $338 from CVS or $162 U.S. from a Canadian pharmacy?

    Or, investigate top Amazon.com diet and nutrition alternatives to cholesterol medication

    In 2003, the Wall Street Journal reported Dr. La Puma patient/WSJ reporter Tom Burton’s success to lower his LDL from 169 to 114 over 9 months. Tom followed Dr. La Puma’s tailored prescription and recipes. Some are free online.

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