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Plavix and Statin Drugs?

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Plavix and Statin Drugs?

Old 02-12-20, 01:19 PM
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bikeme
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Plavix and Statin Drugs?

So, it looks like I'm headed for these. Some background: by the numbers (age, cholesterol levels/ratios, etc.) my doctor said I might need to go on a statin (I hate drugs, btw) but I could confirm the need via a heart scan to show how much plaque had built up. BTW, my cholesterol ratio of HDL to LDL is killer with the LDL just at limit and HDL over limit (the latter pushes my total past limit). Anyway, the scan results said there was a "good amount" of plaque (I can't recall the lingo or numbers they stated). They said I could hold off on a statin until July when I would get tested again. In the meantime, he wants me to do a stress test EKG as well start taking as a baby aspirin daily. I told him that might not be good given I had an ulcer 10 years ago from too much ibuprofen and I'm supposed to avoid NSAIDs now. He then prescribed me Plavix instead. FYI, I turn 60 this year and am in excellent shape--great BP, lean racing form--I race mountain bike XC, which I train very hard for. I'm in my best riding form since 2015--even better, actually, and I don't want to screw it up with drugs. What's your experience with Plavix as well as statin drugs' side-effects and how did they affect your cycling?
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Old 02-12-20, 01:38 PM
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To a hammer all problems look like a nail. To a board certified AMA physician all conditions look like a pill prescription. You have a window of time and opportunity to get a second opinion and possibly a line on another strategy. I am also 60 with excellent BP and etc. I don't race but I weight train and bike commute. I would want to see your other panels especially your hormone profile. Your estrogen might be high and causing you to hold fat. In any case your diet probably has room (a lot) for modification towards a better split for your good HDL/LDL ratio. It might not be a bad idea to see what a ND (natripath) or Integrative Medicine physician thinks. Their approaches usually try to avoid the Big Pharma solutions.
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Old 02-12-20, 01:56 PM
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I was on Pravistatin for high Triglycerides. I got to where I couldn't walk without a lot of pain in my knees. I couldn't do steps or stairs any more. I quit taking it, with doctors ok, and was 100% better within a month. I now take Niacin and prescription fish oil. My Triglycerides are almost in the normal range.
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Old 02-12-20, 03:42 PM
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In the vast majority of people, statins have no major or harmful side effects. I have been on the highest and strongest statins for 21 years. Plavix is a strong anti-clotting, (simplified functional term.) The drug itself is not dangerous but the risk is if you suffer ANY type of injury that causes bleeding. You are going to bleed a lot more on Plavix.

You should try a baby aspirin, the normal dose for someone with what you describe. See if that bothers your stomach. There is a good chance, no guarantee it will not.

I take when you talking about your lipid levels your terminology is a bit confusing to me. I think you are saying that the level of your LDL is too high and your HDL is too low. (Lower LDL is good, higher HDL is good.)
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Old 02-12-20, 06:11 PM
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Yes, "killer' is a very confusing word in modern slang. What are your numbers for total, HDL, and LDL? High coronary calcium in long-time very fit endurance athletes is usually not a concern. It's composed of hard calcium which apparently does not break up and cause heart attacks. Question is, do you fit that definition? Many docs overprescribe statins in such cases. How's your blood pressure and morning resting and standing HRs? I'd certainly recommend going with the stress test. When I was 72 and had a high calcium score, I tested as a fit 47 y.o. That felt good.

The cardio prescribed a statin anyway, which put me in a total tailspin. They are not for everyone. My power immediately went way down due to severe muscle pain and a couple months later I developed polymyalgia rheumatica (PMR). Whether the statin had anything to do with that is an open question. That said, I wish I could take a statin and be fine with it. Statistically it's safer. My cycling doc says in my case, I'm safer riding lots than taking a statin and not doing so. So there's that.

All my cholesterol numbers are in the good range. The cardio prescribed on the basis of my age and calcium score, which would have been correct in the case of a "normal" person.

I take a baby aspirin. I'm placing a bet that I'm less likely to have a concussion than I am to have a coronary blood clot. I don't tree ski in the backcountry anymore.
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Old 02-13-20, 10:46 AM
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Originally Posted by BengalCat View Post
In the vast majority of people, statins have no major or harmful side effects.
"Statins are a linchpin of current approaches to cardiovascular protection: however, AEs of statins are neither vanishingly rare nor of trivial impact. For statins, as for all medications, vigilance for potential AEs is imperative."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849981/

The numbers I have read of are in the range of at least 10% ... and many clinicians think that number is under reported. This is also one of those times when you can drown in a lake that averages only 6 inches deep. If you have side effects it doesn't matter that most people don't.

I tried statins, and they definitely gave me side effects. On my last visit to the Dr. I told him about them and told him that I would rather shave five years off of my life than continue to take them and be crippled with joint pain. He told me he would do the same.
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Old 02-13-20, 11:55 AM
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Originally Posted by Biker395 View Post
"Statins are a linchpin of current approaches to cardiovascular protection: however, AEs of statins are neither vanishingly rare nor of trivial impact. For statins, as for all medications, vigilance for potential AEs is imperative."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849981/

The numbers I have read of are in the range of at least 10%... [citation or reference?]

I tried statins, and they definitely gave me side effects. On my last visit to the Dr. I told him about them and told him that I would rather shave five years off of my life than continue to take them and be crippled with joint pain. He told me he would do the same.
Statins are by far the most important drug in controlling dangerously high lipid levels associated with coronary heart disease. Heart disease of all types is the number one killer of men, women, and children in the Western World.

All drugs have adverse effects or side effects on some people. All drugs.

Overall the vast majority of people that take statins do not have adverse effects. Naturally, that is of little value or comfort to those get AEs from them. Sorry about your experience.

Often when there are adverse effects from statins they can be eliminated or minimized to an acceptable level by lowering the dosage or trying a different brand of statin and other such approaches. Of course, like any drug, unfortunately, there will always be a segment of the population that the level of AE eliminates statins as an option.
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Old 02-13-20, 12:04 PM
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What I quibble with is the use of the term "vast majority." A significant minority do in fact have issues with them.

Personally, I tried two different kinds and with minimal doses, and I was hopeful for good results. In both cases, the side effects appeared. In the second instance, they took a good month to resolve.
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Old 02-13-20, 03:02 PM
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Old 02-13-20, 03:04 PM
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Originally Posted by BengalCat View Post
In the vast majority of people, statins have no major or harmful side effects. I have been on the highest and strongest statins for 21 years. Plavix is a strong anti-clotting, (simplified functional term.) The drug itself is not dangerous but the risk is if you suffer ANY type of injury that causes bleeding. You are going to bleed a lot more on Plavix.

You should try a baby aspirin, the normal dose for someone with what you describe. See if that bothers your stomach. There is a good chance, no guarantee it will not.

I take when you talking about your lipid levels your terminology is a bit confusing to me. I think you are saying that the level of your LDL is too high and your HDL is too low. (Lower LDL is good, higher HDL is good.)
Sorry to confuse you. My LDL is at the top of the "acceptable" range and my HDL is over its "acceptable" range. The ratio of HDL to LDL is very good though. Doctor wants my LDL down to 70.
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Old 02-13-20, 03:22 PM
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I was put on statins a couple of decades ago. Was prescribed several, and none of them affected any significant change in the numbers. But I did experience side effects with all of them. Don't recall which one it was but there was climb on a mtn.bike trail that I used to manage, but after 2-3 wks of taking a statin, could no longer make the climb. Quit the statin (to see if it was coincidence or the statin), and after a few weeks, was once again riding up the hill. So now, I just try to watch my diet and get a fair amount of exercise. And it's helped as much as any statin I had prev. been prescribed. If a statin had worked, after reading much about them, I'd taking some CoQ 10 along with it.
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Old 02-13-20, 05:16 PM
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I tried both hydrophillic and lipophillic statins at various doses while taking 200mg of CoQ10/day. They all seems about the same, muscle pain and loss of power. Thing is, the heart is a muscle, too. Why do people think it only matters that your legs, arms, and back hurt?
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Old 02-13-20, 05:24 PM
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I avoid all that stuff. The keys, as mentioned above, include diet and exercise.
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Old 02-17-20, 12:46 PM
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Originally Posted by Carbonfiberboy View Post
I tried both hydrophillic and lipophillic statins at various doses while taking 200mg of CoQ10/day. They all seems about the same, muscle pain and loss of power. Thing is, the heart is a muscle, too. Why do people think it only matters that your legs, arms, and back hurt?
Have you also considered a water and fat-soluble form of CoQ10 for better absorption or an ubiquinol which is the reduced, active form?
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Old 02-18-20, 10:25 AM
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Originally Posted by rideorfly View Post
Have you also considered a water and fat-soluble form of CoQ10 for better absorption or an ubiquinol which is the reduced, active form?
Thanks for bringing this up. I've been buying Q-SORB branded material, which it turns out is ubiquinone, not particularly effective. I'll switch to ubiquinol, which of course is considerably more expensive - almost 4 times as much! https://www.ncbi.nlm.nih.gov/pubmed/30302465

Maybe I'll notice a difference? We'll see.
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Old 02-18-20, 01:09 PM
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There many good or quality brands of enhanced absorption forms of Ubiquinone and Ubiquinol. The brand I use, Qunol, is about the same price for either form. They are roughly $32 for 120 tabs of 100mg each. Those are Amazon prices.
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Old 02-18-20, 01:22 PM
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Originally Posted by BengalCat View Post
There many good or quality brands of enhanced absorption forms of Ubiquinone and Ubiquinol. The brand I use, Qunol, is about the same price for either form. They are roughly $32 for 120 tabs of 100mg each. Those are Amazon prices.
I've been paying $18 for 250 ubiquinone 100mg soft gels.
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Old 02-18-20, 03:03 PM
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Originally Posted by Carbonfiberboy View Post
I've been paying $18 for 250 ubiquinone 100mg soft gels.
That's certainly a good price. Are they liquid in gel caps with an enahanced absorption ingredient?
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Old 02-18-20, 07:09 PM
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Originally Posted by BengalCat View Post
That's certainly a good price. Are they liquid in gel caps with an enahanced absorption ingredient?
I didn't remember it exactly right, but close: https://www.amazon.com/gp/product/B004R61NCW/
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Old 02-18-20, 10:19 PM
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This is an interesting discussion.
My PCP started me on a low dose statin over two years ago. This past fall I began to have odd symptoms. It started with hip discomfort and stiffness in my hamstrings. A couple of weeks later, my lower back became stiff and sore. This went on for around two months. I then began having shoulder discomfort as well. One shoulder worse than the other. When I plugged these various symptoms into a net search I came up with polymyalgia. Known as PMR for short.

After trying various OTC meds with no relief, I went to see my PCP about it. He agreed that PMR was likely the cause of the discomfort, but my blood work showed no signs that I should (or did) have PMR. He prescribed a 30 day round of Prednisone which cleared the symptoms up within a week. Within a week of the last dose of Prednisone, the symptoms began returning, so he referred me to a rheumatologist.

The rheumatologist prescribed another round of Prednisone, with a followup in 30 days. During the visit he asked about other meds I was taking. When he heard I was on a statin, he insisted I stop taking them asap. That they could cause these symptoms. Time will tell. My followup visit is in April. I should be weaning off the Prednisone again by then.
Just seems odd that statins could cause this after going two years with no problems.
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Old 02-19-20, 10:28 PM
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Originally Posted by missinglink View Post
This is an interesting discussion.
My PCP started me on a low dose statin over two years ago. This past fall I began to have odd symptoms. It started with hip discomfort and stiffness in my hamstrings. A couple of weeks later, my lower back became stiff and sore. This went on for around two months. I then began having shoulder discomfort as well. One shoulder worse than the other. When I plugged these various symptoms into a net search I came up with polymyalgia. Known as PMR for short.

After trying various OTC meds with no relief, I went to see my PCP about it. He agreed that PMR was likely the cause of the discomfort, but my blood work showed no signs that I should (or did) have PMR. He prescribed a 30 day round of Prednisone which cleared the symptoms up within a week. Within a week of the last dose of Prednisone, the symptoms began returning, so he referred me to a rheumatologist.

The rheumatologist prescribed another round of Prednisone, with a followup in 30 days. During the visit he asked about other meds I was taking. When he heard I was on a statin, he insisted I stop taking them asap. That they could cause these symptoms. Time will tell. My followup visit is in April. I should be weaning off the Prednisone again by then.
Just seems odd that statins could cause this after going two years with no problems.
I had a similar experience, but a better rheumatologist, who quickly diagnosed PMR. Even though my blood work wasn't as bad as is typical of PMR, my sed rate was quite high. She put me on a year's prednisone program, gradually tapering down to 1mg from 30. That was about 2 years ago and it hasn't come back. My symptoms were identical to yours. I felt great all the way through my taper.

That your prednisone fixed you right up is considered diagnostic of PMR. The fact that we both discontinued our statin(s), can be seen as a confounding factor. There's a study out there somewhere which found that out of a hospital population of PMR sufferers, there were more statin-takers than statistics suggested. I don't see the benefit to you of starting and stopping the prednisone instead of following the usual prescribed taper. You could look at a second opinion or ask that question of your current rheumatologist.

Oddly enough, a fellow cyclist in his early 60s came down with PMR soon after I did. He was not on a statin and PMR is unusual in people that young. So I wonder about stress on the adrenals which cycling might cause. He and I both ride a lot, and hard. His rheumotologist also prescribed a taper, but of only 6 months.

My understanding is that PMR is essentially a lack of a corticosteroid which is necessary for recovery. The replacement by an exogenous corticosteroid somehow kick starts the production again, though the mechanism of that is unknown and counterintuitive.
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Old 02-20-20, 10:29 AM
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Originally Posted by Carbonfiberboy View Post
I had a similar experience, but a better rheumatologist, who quickly diagnosed PMR. Even though my blood work wasn't as bad as is typical of PMR, my sed rate was quite high. She put me on a year's prednisone program, gradually tapering down to 1mg from 30. That was about 2 years ago and it hasn't come back. My symptoms were identical to yours. I felt great all the way through my taper.

That your prednisone fixed you right up is considered diagnostic of PMR. The fact that we both discontinued our statin(s), can be seen as a confounding factor. There's a study out there somewhere which found that out of a hospital population of PMR sufferers, there were more statin-takers than statistics suggested. I don't see the benefit to you of starting and stopping the prednisone instead of following the usual prescribed taper. You could look at a second opinion or ask that question of your current rheumatologist.

Oddly enough, a fellow cyclist in his early 60s came down with PMR soon after I did. He was not on a statin and PMR is unusual in people that young. So I wonder about stress on the adrenals which cycling might cause. He and I both ride a lot, and hard. His rheumotologist also prescribed a taper, but of only 6 months.

My understanding is that PMR is essentially a lack of a corticosteroid which is necessary for recovery. The replacement by an exogenous corticosteroid somehow kick starts the production again, though the mechanism of that is unknown and counterintuitive.
First, Thank you for sharing your thoughts and experiences. Very helpful.

I'd like to clarify my predsisone use regarding the taper down, now that I have my notes in front of me.
My PCP started me on 10mg Jan3rd this year. I'll copy/past his note to me:

"Inflammation markers in normal range.
We will try the low dose prednisone at 10 mg and see if this helps. If symptoms resolve then yes this is polymyalgia rheumatica.
Take 10 mg for the next three weeks, then cut to 1/2 pill for one week then discontinue."


My referral appt to the Rheumatologist was feb13th. His instructions were 10mg of Predsinone for 6 weeks, then 1/2 dose until my followup visit on April 9th.
Since my previous post, I've received a call saying that my blood work done my the Rheumatologist also came back showing all Inflammation markers in normal range.

So, the taper down is happening (10 to 5 mg), and I now have a better understanding of it's purpose.
I'm currently feeling about 95% 'normal". The only discomfort remaining is in right shoulder.

On a somewhat bizarre observation - I've noticed that the symptoms (with or without Predsinone) rise and fall with cold and warm weather. In my area of north central Texas this time of year, we tend to go from 60s-70s to 30s-40s on an almost weekly basis it seems.

Lastly, I'd like to apologize for any 'thread drift' I may have caused from statin use.
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Old 07-23-20, 09:41 AM
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The Big Update! It's 6 months later (the time period my doctor said I had before getting my blood retested). Back in February when I started this thread, he said I couldn't affect my LDL with diet and exercise alone. I was at 106 then (the high end of the "acceptable" range is 105--a new value, btw--the previous range always had me well within it). Anyway, I made some some big changes to what I ate because I didn't want to go on a statin. And thanks to Covid, I cut out what little fast food I ate because I wasn't out and about as much. Significant diet changes included more plant-based protein meals using lentils, beans, etc., more fish during the week, nuts for snacks, etc. I upped my training too and lost another 7 pounds since February for a total of 12 pounds since end of last Summer. My LDL just tested at 71--he wanted me down to 70 and said there's no way I could do that without a drug. HA!!! My next question to my doctor is why am I on baby aspirin?--my BP is fine and my cardio stress test came back clear. I feel awesome and am killing it at age 60, both on group rides and at mtb races.
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Old 07-23-20, 12:21 PM
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Originally Posted by missinglink View Post
<snip> The only discomfort remaining is in right shoulder. <snip>
Google "john kirsch shoulder pain." Fixed me right up.
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Old 07-23-20, 12:27 PM
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Originally Posted by bikeme View Post
The Big Update! It's 6 months later (the time period my doctor said I had before getting my blood retested). Back in February when I started this thread, he said I couldn't affect my LDL with diet and exercise alone. I was at 106 then (the high end of the "acceptable" range is 105--a new value, btw--the previous range always had me well within it). Anyway, I made some some big changes to what I ate because I didn't want to go on a statin. And thanks to Covid, I cut out what little fast food I ate because I wasn't out and about as much. Significant diet changes included more plant-based protein meals using lentils, beans, etc., more fish during the week, nuts for snacks, etc. I upped my training too and lost another 7 pounds since February for a total of 12 pounds since end of last Summer. My LDL just tested at 71--he wanted me down to 70 and said there's no way I could do that without a drug. HA!!! My next question to my doctor is why am I on baby aspirin?--my BP is fine and my cardio stress test came back clear. I feel awesome and am killing it at age 60, both on group rides and at mtb races.
Yeah, ask. I used to take baby aspirin, but dropped it when the new studies came out last year.
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