Statin drugs do not lower cholesterol levels as expected
Dr. Keith Roach
Dr. Dear Roach: She is a 93-year-old woman in good health. I take 40 mg of lovastatin once a day for high cholesterol, but my cholesterol levels are always high when tested. My doctor is not concerned, but I am. Why doesn’t lovastatin lower my cholesterol to normal?
– SA
Dear SA: Lovastatin (Mevacor) was the first statin drug approved, but newer statin drugs are more potent and have less potential for side effects. So, I don’t have a single lovastatin patient anymore. However, you can be sure that your cholesterol level would be higher if you were to stop lovastatin.
If you wanted, you could switch to a stronger drug, such as rosuvastatin or atorvastatin, which would lower your cholesterol even more.
However, information about people your age is really lacking. We don’t know if lovastatin really helps you. Some of my patients in their 80s and 90s choose to continue taking it, and data shows that it continues to help prevent heart disease in older people. Statins are especially important for people at high risk. However, some choose to get off the drug, especially if it causes side effects or interacts with another drug.
Dr. Dear Roach: I have very bad side effects with levothyroxine and Synthroid. Is Cytomel an option? Are there other medications?
— PL
Dear PL: There are two major thyroid hormones (levothyroxine and triiodothyronine) used for thyroid treatment. The drug is levothyroxine, also called T4, and the most popular name for levothyroxine is Synthroid. T4 does not have much thyroid function itself, but is converted in the body to the active form of the hormone, triiodothyronine, also called T3. T3 is also available under the name Cytomel (which is the natural equivalent of T3, also called liothyronine).
T4 is a common treatment because it uses the body’s way of making the hormone. T3 is absorbed quickly and used quickly, which can lead to changes in thyroid hormone during the day, even if it is taken twice a day. In addition, people treated with T3 had a higher risk of heart failure and stroke compared to T4 users, possibly because they had more thyroid hormones during the day.
I don’t know what side effects you have. Sometimes, I see someone respond well to one manufacturer of thyroxine, and I will ask the pharmacist to fill the prescription with that manufacturer instead.
Dr. Dear Roach: I am writing about a recent answer you gave about sunburn. I have heard that a short exposure to the sun each day (eg 10 minutes) is the best way to get vitamin D. What are your thoughts on this?
– CS
Dear CS: Most people don’t need to worry about vitamin D. Ten minutes of sun exposure on your hands and face is enough to get the vitamin D you need. Vitamin D supplementation has not been found to be beneficial in a recent large study, so I wouldn’t risk sun damage by getting a sunburn, even for 10 minutes, if your goal is to get more vitamin D.
People who need to consider getting more vitamin D include those with osteoporosis; people who don’t see the sun at all (either people who can’t go home, live in an educational institution, or wear sunscreen); people who cannot absorb vitamins (celiacs or those undergoing bariatric surgery); and people taking medicines that speed up the metabolism of vitamin D (seizure drugs like carbamazepine). Vitamin D status is indicated in these cases.
Readers can send questions to ToYourGoodHealth@med.cornell.edu.
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