Approaches to Lowering LDL-C. What is new in 2021 for Statin Intolerant Patient?

This webinar was originally recorded on September 2,2021 and our speaker, Leslie Cho, MD, discussed applying best practices for evaluating and modifying medications when facing statin intolerance.

[joannwill]

If anybody told me I needed to retry statins I would just refuse to take them. I've already tried 4 of them. The last one was pravastatin. I was in PT two different times due to the pain. My back, legs and knee hurt so much. I couldn't walk down the stairs, put my shoes and socks on, can't clean my house, can't do the yard work, go for a walk. Heck it hurt to stand there and do the dishes. My Dr's office is just working on getting approval for repatha. Not sure if my insurance will approve it but if not I will live the rest of my life pain free with no statins.

[peckz]

You did not talk about glucose rise because of statins.

[CurtinFortCollins]

While there was a 59% reduction in LDL in the Fourier study, there was only a 0.1% difference in mortality benefit . Hardly an endorsement. You may want to look at absolute risk reduction rather than the relative risk reductions paid for by the pharmaceutical industry. Just a though.

[michah]

Her approach to people who can't take statins, tell them they're imagining the side effects

[AZ]

What about the meta analysis with CoQ10 at 200mg/day resulting in significant reduction in SAMS?

[spellcop]

does diet and exercise work as well in familial hypercholesterolemia cases? and which statin works best for this group? and which is also safe for already prediabetic cases?

[franciscoadolfo]

Sobering as she discusses the 51 yoa patient and there's no alarms to TG of 231, HDL of 32, and a1c of 6.6. As if these markers are ok as long as the LDL is 95. And most likely will be added a second cholesterol lowering drug to bring it LDL to 50
Would love to see this patient labs as far as available

[donnagleewilliams]

You would think that, in a presentation by this title, she wouldn’t just say “it’s difficult to lower Ldl-C using diet, ” but would perhaps give just a LITTLE attention to who is doing it, how they are doing it, what peer-reviewed research supports it, and the fact that it’s so effective that Medicare and insurance companies are now paying for Ornish’s training in doing it. Because you think something is “difficult”—for you—doesn’t mean you get to ignore it.

[wenbray]

What are side affects of bempedoic acid. What are side affects of repatha.

[donnagleewilliams]

I do give her credit for mentioning the fact that some studies pre-eliminated all patients that couldn’t tolerate statins from the study pool.

[janerogers]

Trying Crestor… known to have the least side effects. ? 2.5 mg to 5 mg effectiveness? Or qod or even once a week? I always develop muscle pain. Looking for options

[b.hammersley]

Hello Dr Cho. You mention that there is such great data showing that it is really important for those who have had a heart attack or bypass surgery to get a LDL-C level of less than 70. Please let me know what this data is. I had a heart bypass 13 years ago and my typical LDL-C level is 155. I haven't had any angina for many years so your statement is a trifle odd. But I would be interested to examine the data to which you refer.

[williewonka]

Interesting that none of the studies consider the assigned dose for the patients. Patients with the maximum dose are accorded the same weighting as patients with the lowest dose. As someone prescribed the maximum dose for simvastatin, Pravacol, Lipitor and Crestor I experienced muscle problems and brain problems with the first three. I became concerned with the risk of developing diabetes from statins. So, which is worse; high cholesterol or diabetes and its effects? I no longer trust pharma studies of their own "blockbuster" products. These studies repeatedly bias the data sets to get the results that support FDA approval of the product.

[davejcoffey]

How to take statins:
Dump whole bottle in water and flush 🚽

[RoadMechanic]

if PCSK9 is so effective, why not start with that alone?

[joshuahandfinger]

solely focusing on ldlc when science shows heart disease risk factors like insulin resistance diabetes etc are way more important in cvd seems illogical

[joycemosakowski]

You forgot to mention hair loss with taking stains

[michah]

And of course talking to elderly people on the phone will accurately measure their cognitive function and prove beyond debate that the statins don't make a difference 🙄

[ang]

blindly lower LDL is wrong. cholesterol is needed by our body! blindly lowering LDL may cause lack of cholesterol and may kill one faster. If plaque is formed by LDL is true, everyone in the earth should have plague in one's body since everyone does have LDL! and LDL level and plaque should be in proportion that means higer LDL must have more plaques but there is no evidence that this is true. Besides, higher LDL and lower LDL level has similar risk factor of heart attack! Also LDL alone will never form plaques! seems doctors over-Simplified the plaque formation process

[michah]

I LOATHE the smugness about the study where they tricked the people. It's gaslighting to tell people they aren't expecting what they're experiencing and I don't know why the smugness is always part of it. Also, was it possible those people weren't actually taking the medicine and saying they were? And btw, that's what people do when you treat them like an idiot. They'll just take it a few days before the blood work and that actually works keep being smug and relying on this ' study' and keep making enemies of your patients.