GeorgeB
Thanks
Do you have a location or name for that statin& niacin trial?
It is tough to evaluate ANY medicine from a single smallish short duration trial
especially something that modifies heart disease-a disease with a long "lag time"

Niacin+ statins "should" work-plausible that they would be synergistic-but that doesn't mean they will of course-lotta plausible meds and combination don't "work"
My reason for considering niacin with the lipitor is my wife can only tolerate a tiny-5-6mg/d dose of lipitor-
it-40 mg- made her legs very weak-and it spiked her insulin requirement- 60 units on 40 mg 37 units on 5-6mg
so obviously I think statins "work" but they are a long way from side effect free- muscle weakness and insulin tolerance
Part of the reason I took the lipitor-is I wanted to see if I noticed "anything" negative-SURE AS HECK DID- I feel "fuzzy" and legs -quads-get sore taking a very small 10mg every other day-dose.
So I'm thinking maybe a smallish-100 mg TID dose of niacin-immediate release-forget extended or sustained release- you liver needs niacin free intervals
Yes they claim you need more-but got my doubts about that-it isn't as if it is an antibiotic and you develop resistance on sub clinical doses

Yeah-the statins work(according to many many studies)-but no free lunch-
my guess is many patients taking them-are old-taking soooo many meds and have so many health problems-that when they slowly get weaker don't feel right- it just isn't "noticed" and they end up in a nursing home
Many cardiologists probably will honestly say "very few of my patients have problems with statins"
Oldster walks in-maybe a bit more slowly-but how is a MD going to detect that?? He won't!! Hell- the cardio won't EVER see the oldster walk in since the patient will be in the office waiting for MD- MD will NEVER evaluate something as subtle as a slightly slower walk??
But nothing better than statins-so..... what choice do you have if you have heart blood vessel disease?? None-or maybe Zetia?? (joke)
Nothing is BETTER than statins for decreasing MIs ....
There are some MABs in development-supposed to block cholesterol production I think-more specific than statins-but they aren't "out yet"(I think it is MABs-monoclonal antibodies but might have gotten that wrong-might be wrong on mechanism also-quick glance at something 2 months ago)
and they will be HORRENDOUSLY expensive
Heart disease-you are stuck with STATINS- simple as that
Fact that meds like the MAB are in development clearly indicates BIG PHARM fully aware of statins limitations

The trial was called "AIM-HIGH" - Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy
and the conclusion went:
'Among patients with atherosclerotic cardiovascular disease and LDL cholesterol levels of less than 70 mg per deciliter (1.81 mmol per liter), there was no incremental clinical benefit from the addition of niacin to statin therapy during a 36-month follow-up period, despite significant improvements in HDL cholesterol and triglyceride levels. "

And by 'clinical benefit' they mean the hard outcomes they were measuring: "death from coronary heart disease, nonfatal myocardial infarction, ischemic stroke, hospitalization for an acute coronary syndrome, or symptom-driven coronary or cerebral revascularization."
... As opposed to many trials that measure 'soft' outcomes such as LDL levels and such.

But it is important to realize the trial was using people whose LDL levels were already well controlled. In your wife's case that may not be true.

And while most cardiologists would agree that you are stuck with statins if you have heart disease, not everybody would. Some believe that diet and exercise can do as much or more than statins -- without the side affects....

But, I totally agree with you that no doctor will see the gradual decline that statins may produce and, since those declines are often blamed on aging, the poor person ends up in a nursing home. Actually, for myself, I didn't even see them... All I knew was that I didn't seem to have the strength I thought I should have nor the energy -- and I looked everywhere, except at the statin, for the cause. But the COQ10 supplement resolved the deficiency and both my strength as my energy returned as soon as I started taking it.

But, to be honest, taking it came from me. NOT my cardiologist, not my endocrinologist and not my wellness doctor. They all said: "Well, you can take it if you want, it won't hurt you physically, just your wallet...".

GeorgeB
Thanks.
Their comment was in respect to Q10??
Now since Q10 doesn't get the scrutiny that the statins-and other prescription meds get-they really DON'T know that it is harmless.
Perhaps the anti-inflammatory effect of the statins IS related to depleting Q10?? Yes-this is "just supposing"
but since it really isn't clear WHY statins improve cardiac outcomes "more" than they should-since the cholesterol effect isn't "all" there is to it.
Yeah-just can't know what you can't know.
Niacin-a coenzyme also like Q10- can be toxic-

On the other hand-I increased my Q10 dose- 250 mg last 24 hrs-and I "feel" better-less "foggy" felt better climbing the levee-
Now really impossible to quantify "feel a little better" but I'll stay on 200-300 mg-see what happens.
My wife takes SOOO many medications that I don't want to jack her Q10 up until I see if it "kills me" 1st.
Prednisone-for vasculitis
cellcept -vasculitis
plavix-platlet
aspirin platlet
Lipitor-statin
Renexa-angina
Carvedilol- beta blocker-BP and heart
Lisinopril-BP and heart
insulin-diabetes from prednisone-worse on statin
nystatin mouth rinse for yeast infection-from prednisone
naproxyn as needed Nitroglycerin as needed
Q10= 100 mg/d for now.

Lotta meds-at least 7 crucial-better not miss many doses
Thanks
Charlie
PS What sort of dose are people taking-Q10?? older less expensive version not the latest more expensive version.

I am aware Zetia is not a statin. The point I was taking trying to make was that the drug lowers cholesterol numbers but the pharmaceutical company is forced to concede that it does not lower heart attack risk. Lowering cholesterol numbers through drugs seems pointless. Statins have such profound multiple effects that I find the claim plausible that they to may happen to have some anti-inflammatory effect that reduces the risk of second heart attck for some. But the bad side effects of statins make it criminal, IMHO, how widely they are pushed.

The public would be much better off examining why their cholesterol #s are what they are and addressing that through lifestyle changes -- taking high LDL and low HDL not as a direct cause of heart disease, but as an indicator. CRP, triglyceride levels, VLDL, HbA1c should be looked at. The automatic flagging of total cholesterol numbers is ignorant.

Zetia is probably being sold because it ISN'T A STATIN.
I suspect that is the angle the drug reps use
"if you have a patient that can't tolerate statins-complains of muscle weakness pain etc-give them Zetia"
All those markers you mentioned-are looked at
Lifestyle changes-frequently aren't in the cards for oldsters with heart disease-but they want to live also
They sure as heck can't spend 1 hr on a bike- or change diet dramatically-
hell 20% of adults still smoke-lifestyle changes-EASY to say-tough to do.

All drugs have side effects-all drugs.

So what is the point of lowering a cholesterol numbers with Zetia when Zetia has not been found to reduce the incidence of heart disease? Numbers do not matter, outcomes matter. Regards life-style changes, maybe I am a hard-ass, but I would say "can't" is the wrong word -- should be "won't." That problem is not helped by the availability of a pill that make you feel good about your cholesterol numbers even though the labeling concedes the pill is worthless for its intended purpose of preventing heart disease. All too many doctors have become jaded where they take the easy way out and write scripts when the need to be far more aggressive about lifestyle. To understand one reason why, poll all the medical professionals you know and ask them what their required ongoing education consists of. In most cases, it will be paid vacations sponsored by drug companies pushing their latest and most profitable meds.

"All drugs have side effects." You are correct. That is why I do not take a drug without a clear and compelling reason such as the eyedrops that are keeping my glaucoma at bay.

Don in Austin

Sometimes if you wait for a compelling reason-meaning an MI in the case of statins
"Barn Door"

Yes, we, as a nation need to get away from treatment of diseases and conditions and focus more on prevention.

That was drilled into me working as a cost accountant for an aluminum extruder. It was far more expensive to "fix" a bad product that had already been shipped to a client than to simply make sure that bad product never happened - or was removed from the process as soon as it happened.

It was drilled into me again working as a systems developer / system analyst: It was far cheaper to prevent a coding error from going into live, production status that it was to fix it once it was installed and causing problems.

And, it was drilled into me again as a nurse: It's cheaper to prevent heart disease (and other chronic diseases like dementia) than to fix it after it happened.

THIS IS NOT ROCKET SCIENCE!

... And the best prevention is life style changes: Good sleep habits, stress reduction, good diet, and exercise. (I used to say all of those were free -- but then I started cycling! ). But too, sometimes those lifestyle changes need a little help!

99% of cardiologists would put statins in the prevention category
Heck-maybe 99.9%
Maybe they should all take statins for a month or two-

Prevention by taking a liver toxin with multiple significant side effects is not for me. I understand the limits to anecdotal evidence, but I personally know a great many individuals who had major side effects from statins. And these were people who had been persuaded that statins were great for their health and wanted to believe in them, but were clearly suffering muscle pain, dementia etc. i was prescribed them years ago and only made 5 days because I felt ill the whole time like I had a hangover. I will get my prevention through exercise and trying to eat and sleep right and after that take my chances.

Don in Austin

Yes I noticed something like that- I feel "foggy" the morning after my every other day 10mg of lipitor.Hard to quantify "foggy" probably very hard for an even older not very active person to quantify it. I just feel a bit "off"
My muscles-specifically quads- got sore after my usual ride
I have done EXACTLY the same ride-up and down the levee for 25 minutes- after 9 minutes riding there-9 minutes home-for 5 years.
No muscle soreness- knee soreness-yeah- I have gimpy knees- but no muscle soreness

So yeah-I do think statins cause significant side effects.Just go online-you will find many many people ascribing various side effects to them.
But their docs-see another side.They see ALL THOSE STUDIES showing people live longer and have fewer MIs

+1 for looking into niacin. As I recall there are other benefits and to be honest a niacin flush isn't that unpleasant. If you take it regularly the flush feeling also diminishes. I don't currently take Niacin but have in the past. Currently I'm taking Beta-Alanine which give you the exact same flush. I've been taking it for a few months now and unless i think about it I hardly notice the effect at all.

Update
Maybe 200 mg Q-10 is slightly improving fogginess-but it is still there.
My legs seem to not be as "worn"
so maybe it works-really hard to tell-not as if I can blind myself
and tough to quantify "sore quads" and "I feel foggy"
On the bright side the Q-10 hasn't killed me-a big plus

The Q10 can help relieve ONE of the side affects of statins:

It can replenish the Q10 enzyme the body needs to make ATP. Without ATP, your muscles don't work. Statins block the production of Q10 as part of the same process they use to block the production of cholesterol...

For the other side affects....
.... Wait, what was I talking about again**********

I guess Q10 has its own "Side Effects"

As soon as I started taking it I felt an immediate and very dramatic increase in strength -- so I started powering on up that 5 mile hill -- and for the rest of my usual 20 mile ride. Harder, and harder...

Then suddenly, I started getting knee pain -- even though I hadn't had any ever before in life, my bikes are correctly and professionally fitted, and I hadn't had a problem in well over 5,000 miles of cycling...

I made an appointment with a sports medicine physician (Thursday, 2 day from now).

BUt, doing some research in my anatomy books I realized I probably did not hurt my knee. Based on where the pain is and how it happened, I am thinking my Sartorius muscle (which wraps over top of the quads) got a little too strong for the tendon that holds it to the tibia and tore it -- hopefully just a little...

.... Oh well... But its been two weeks now without cycling and I'm getting withdrawal --especially now that I just got my original bike back from the LBS. It was the donated bike that got me started and now longer fit me. He put on a new stem and handle bar and fitted it to me very nicely.
.... And now I can't even try it!

Damn Q10 !

See
no free lunch!

No, no free lunch.

But I look at the Q10 as simply returning the stolen goods that the statin (Crestor) stole from me (my strength!)...
... Actually, I am looking at it not as an excess of strength (God Only Knows!) -- but as a return of strength that happened unnaturally quickly -- too quickly -- and my body was not able to adapt quickly enough. Basically, it threw things out of sync... There was simply no way that I should have increased my power that quickly....

But it was fun. I had visions of seeing Lance over my shoulder trying to keep up with the old guy...

Hey-considering what "meds" Lance used-it would take more-A LOT MORE-than Q-10 to out him in your rearview mirror!

Watch this, 2 parts of a program on the cholesterol myth and statin abuse.

https://vimeo.com/77730824

https://vimeo.com/78259209

I would say to be very careful with this advise. It was clear to me that they were doing 2 things:
1) Cherry picking which studies they would look at or not look at
2) Oversimplifying with a black and white: "Cholesterol is the problem" vs "Cholesterol is NOT the problem".

Which is similar to what the drug companies have done with their cholesterol lowering drugs (just on the opposite side).

Modern, higher quality science rises above that and recognizes that the causes of heart disease cannot be distilled down into a single cause.
-- Does stress contribute: Yes
-- Does depression contribute: Yes
-- Does a sedentary lifestyle contribute: Yes
-- Does obesity contribute: Yes
-- Does High Blood Pressure contribute: Yes
-- Does diabetes contribute: Yes
-- Do refined carbs contribute: Yes
-- Does a deficiency of Nitric Oxide contribute: Yes
-- Does inflammation contribute: Yes
-- Does an unfavorable cholesterol profile contribute: Yes

There is solid evidence to support all of those causes... But to "prove" that any one of them is not a factor only requires a little marketing...

But, all in all, the video was not bad in that it stated that cholesterol is not the ONLY cause of heart disease.
... On that I agree...

But, I disagree with its implications that an unfavorable cholesterol profile will have no influence on heart disease and can be ignored.

https://mobile.nytimes.com/blogs/well...s-of-exercise/

"The unmedicated volunteers improved their aerobic fitness significantly after three months of exercise, by more than 10 percent on average. But the volunteers taking the statins gained barely 1 percent on average in their fitness, and some possessed less aerobic capacity at the end of the study than at its start."

The article mentions that simvastatin was the medication in the study. I can't help but wonder if my lack of progress in returning to running and faster biking at this stage in my life at age 58, now that I take simvastatin, might be attributable to the medication to some degree. Or is it the smoking of 2 packs a day of full-tar Salems for 12 years in my 20's and 30's catching up with me. Or a combination?

Has anyone moved off simvastatin to another statin such as Lipitor and seen performance gains in their aerobic activities?


Brian

Thanks for sharing that article. It was good reading -- and fits with what I have learned about statins (but physicians tend to ignore...)

My own experience is: I started taking Baycol in 1996 and experienced full blown myopathy with it (where the muscle tissue actually breaks down). The physician switched me to Pravastatin and my muscle problems largely went away. Later I switched to Crestor because it is less likely to harm muscle tissue and, it does not cross the blood-brain barrier.

I thought Crestor was fine -- I had no adverse side affects from it -- UNTIL I started exercising. I noticed that I simply had no power and little aerobic capacity. When I saw a cardiologist who administered a stess test that confirmed that I had no cardiac issues going on -- but even though I was cycling 125-150 miles a week, my aerobic capacity was far below where it should have been.

Then, with his approval, I started taking CoEnzyme Q10. And I IMMEDIATELY saw a dramatic improvement in my strength and aerobic capacity. Actually, it took a little bit to get the dosage adjusted -- I found that I had to take 200mg twice a day because the effects tended to fade by the afternoon.

And, that made sense: ALL statins, without exception decrease the body's production of Q10. And, Q10 is required for the mitochondria to produce ATP -- which is the fuel the muscles use during aerobic metabolism. And, it is used more by the heart than any other single muscle. If you deprive the body of Q10, you deprive the muscles of the energy they need to do their job.

Cardiologists will almost universally tell you: "Some people have seen benefit from it, you can try it".

It has no documented adverse effects.

Then, this past New Years day I stopped taking the statin (under the cardiologists approval). I have to say that I feel much better. Mostly I find that my stiffness has mostly gone away and I seem to be more limber and flexible (stiffness is another side affect of statins that physicians tend to ignore or marginalize). But, I did not see any improvement in power or aerobic capacity -- but that makes sense because the Q10 I was taking had already offset those side affects.

I strongly suggest that if you are taking a statin and exericising that you give Q10 a try. My cardiologist told me to take at least 200 mg a day. I found that helped but the effects faded by afternoon -- so I now take 200mg twice a day.

If you want to know more about it, this is the best, most complete study I have seen on it:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096178/

This study concludes with the following:
"A population that would appear to gain the most benefit from coenzyme Q10 supplementation would be that population with all the mentioned characteristics. An elderly population of athletes receiving HMA Co-A reductase inhibitors would appear to be ideally suited to experiencing the greatest benefit from coenzyme Q10 supplementation, given the high risk of mitochondrial dysfunction from coenzyme Q10 deficiencies in this group."

Thanks again for sharing that article -- and best of luck with the statin. I am giving it try being off of a statin and REALLY liking it. I go back to the see the cardiologist in May where he will retest my cholesterol and we will make a decision if I should go back to taking a statin. I REALLY do not want to. Please wish me luck!

I've quit taking Simvastatin due to the incredible ITCHING!!

That's the rumour alright!

Abso-frigg'n-lutely!! I took niacin when I was also taking Simvastatin and had a REALLY nasty skin rash.