How low do you go?
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How low do you go?
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I saw a patient in clinic in last week who asked me whether his cholesterol was 'too low'. He had an LDL of 1.2 and an HDL of 0.7 measured by his primary care physician off all treatment as part of r
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Forums » Open clinical » Cardiology » How low do you go?
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How low do you go?
posted at 31/8/2011 8:33 PM BST
on bmj.com
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Posts: 875
First: 17/6/2011 Last: 20/5/2013 |
I saw a patient in clinic in last week who asked me whether his cholesterol was 'too low'. He had an LDL of 1.2 and an HDL of 0.7 measured by his primary care physician off all treatment as part of risk assessment. Unfortunately the following week he suffered a STEMI and underwent primary PCI and then was started on atorvastatin 80mg /day. He is currently taking 10mg atorva a day and has an LDL of 0.6 and an HDL of 1.1. He wanted to know whether he should continue his statin - what would you recommend? |
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Re: How low do you go?
posted at 1/9/2011 2:34 AM BST
on bmj.com
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Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
Hello Sadian: But I would also alert him about the serious mood and behaviour disorders associated with statins utilization and secondary very low Cholesterol levels like memory deficits, aggressive and violent behaviour, hostility, depression, anger and rage. All included. Afterwards statins are not all that good...... All Best, Joey
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Re: How low do you go?
posted at 1/9/2011 5:08 PM BST
on bmj.com
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Posts: 875
First: 17/6/2011 Last: 20/5/2013 |
Hi Joey R , apologies but the numbers I quoted are in mmol/l. This gives my patient an ldl in mg/dl of about 27 on the minimum dose of atorvastatin. Would this alter your thoughts? best sadian |
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Re: How low do you go?
posted at 1/9/2011 9:51 PM BST
on bmj.com
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Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
In Response to Re: How low do you go?: Hi Joey R , apologies but the numbers I quoted are in mmol/l. This gives my patient an ldl in mg/dl of about 27 on the minimum dose of atorvastatin. Would this alter your thoughts? best sadian Posted by sadian Hello Sadian: This LDL-Cholesterol is really low!!! My recommendations would be highly indidualised. I would request a hsCRP. I am not convinced about hsCRP as a target for treatment, but I find it a very reliable and very sensitive biomarker of systemic inflammation. And coronary artery disease is indeed an inflammatory disease! So, I use a lot hsCRP for the evaluation of systemic inflammation. The team from the JUPITER trial propose the REYNOLDS risk score that also use the hsCRP level. Hope it helps. All Best, Joey |
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Re: How low do you go?
posted at 2/9/2011 3:10 PM BST
on bmj.com
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Posts: 875
First: 17/6/2011 Last: 20/5/2013 |
I suggested he continue the low dose statin - my logic being that he clearly is at high risk of events- he has already had a STEMI and I believe that there PROVE-IT substudy that looked at those patients with very low LDL levels which suggested no adverse outcome. I don't believe that I have seen much personality change/ aggression / suicidal ideation with statins - how much have you seen and is it because that low an LDL is very uncommon in the Western population? |
Forums » Open clinical » Cardiology » How low do you go?
