UKC

A medical quickie.

I have been on a low dose statin (simvastatin 10) and low dose blood pressure (amlodipine 5) tablet for years.

My latest annual blood test was fine all counts, but the doc wants to up the strength of the simvastain (to 40).

Anyone with a medical background know why - I would have asked him but the consultation was over the phone as there are no appointments before we head off abroad again, by the time I thought of it, he was away?

Cheers


Chris (age 65.9)

In reply to Chris Craggs:

No medical training, but I've been on simvistain for years. I was on 10mg but my GP increased it to 20mg about 3 years ago. Doesn't seem to have caused any significant problems, although an increased looseness of bowls may be due to it.

Have you looked a diet? I only buy low fat milk, avoid cream - most of the time apart from a relapse during the strawberry season - and avoid fatty meat and am gradually switching to more fish and veggie options.

An increase from 10mg to 40mg sounds like a big jump, has your cholesterol level risen significantly? How long are you going for? I don't suppose a couple of weeks will make a significant difference if you stay on existing and avoid fatty foods, but longer maybe you should take his advice for now and book a consultation with him/her for your return

In reply to Chris Craggs:

Hi Chris,
That sounds a huge jump: 20 sounds reasonable but 40.? I am no doctor but I am sure that sticking with your ten, or twenty if he'll prescribe it is not going to do any harm while you are away if you've been on 10 for years and your chlorestorel levels haven't upped since your previous blood test. Presumably youve got copies of your earlier analyses. I've been on 20 for years and my French Doctor is perfectly satisfied with that as my levels seem pretty stable: my wife's Doctor likewise.

And presumably you are off climbing and not on a tour of the flesh pots of Europe. However, that is no more than a personal and not a scientific opinion. And English and French medical opinions frequently differ.
Enjoy the trip
John

In reply to Chris Craggs:

Might there be a statistical reason why they've upped the dose like this?

To explain what I mean, I'm not on any kind of cholesterol medication, but with being type 1 diabetic if I get to a certain age (I think it's 40) and my cholesterol is above a certain level, I'll be put onto medication to help control it even if it's at a level which is healthy enough for anybody who is a none diabetic.

In reply to Chris Craggs:

10mg Simva is a very low dose, were you on it because you got side effects at higher? It's not straight forward but in a nutshell: you have primary and secondary prevention, the second if you've actually had a heart attack, stroke, or other similar event. For primary prevention there is little good evidence for aiming for an actual target of total chol or LDL, so probably just best to fire and forget. Since it's off patent now and slightly superior in outcomes, atorvastatin 40mg is now fairly standard, and it has fewer potential drug interactions than Simva.
Dose is sometimes reduced for side effects, or possibly switched to something like fluvastat or prava.

Secondary is different, there's more evidence for specific targets, usually under 4 total chol and 2 LDL, and doses of atorvastatin 80mg and higher are more usual.

In reply to damowilk:

Thanks for that, he initially said simvastatin 40 but then said atorvastain 20 might better (I tied to keep the story simple). I have no problems with any of the bloods result - "all normal" was the report, as they have been for years.

We are going away for at least 4 months and I was wary of starting something new in case of adverse reactions,


Chris

In reply to Timmd:

The choice of when to offer statins for primary prevention is usually based on the cardiovascular risk score using things like BP, BMI, age, smoking status, family history, diabetes etc

In reply to Chris Craggs:

There's very little urgency, we're talking about 10yr risk, so I'd switch when you're back

In reply to Chris Craggs:

It's not exact, but atorvastatin is approximately 4 times as potent as Simva, numerical dose for dose, but less likely to have the muscle ache side effects at equivalent dose.

In reply to damowilk:


I agree, 10mg *could* almost be regarded as a token gesture by the prescribing GP. 40mg is a fairly standard dosage.

In reply to all:

Cheers for the responses - some very useful stuff there.

On the phone the doc actually asked me why I was only on 10mg, which is odd, I have been on them since 2008 and he has been happy enough to sign me off on my annual visit every year. I'll try to get a cancellation before we go away to discuss it with him,

Chris

In reply to Chris Craggs:




Have a great trip old bean and please; be well.
One day (we've spoken before) you should head further south. Happy to show you the Gramps & Araps.
Cheers,
And. x

In reply to AP Melbourne:





Old bean, like it! Has been more like

Chris

In reply to Chris Craggs:

10mg simvastatin is a homeopathic dose, 40mg a normal dose. If you need it, take a proper dose, otherwise you get loads of hassle with travel insurance for no benefit. If I remember correctly, BMC insurance is happy with one dose of either statin or anti hypertensive, but not if you need a dose of both.

In reply to Chris Craggs:


He'd obviously noticed your penchant for a Full English on facebook!