The statin drug does not lower cholesterol as expected

Dear Dr. ROACH: I am a 93-year-old woman in good health. I take 40 mg of lovastatin once a day for high cholesterol, but when I measure my cholesterol levels are always high. My doctor isn't worried, but I am. Why doesn't lovastatin lower my cholesterol to normal? — SA
ANSWER: Lovastatin (Mevacor) was the first statin drug approved, but newer statin drugs are more effective and have a lower chance of side effects. So I no longer have a single patient taking lovastatin. However, you can be sure that your cholesterol levels would be higher if you stopped taking lovastatin.
If you want, you can switch to a more effective drug such as rosuvastatin or atorvastatin, which would most likely lower your cholesterol levels even further.
However, there is a real lack of data on people in your age group. We don't know if lovastatin will really help you. Some of my patients in their 80s and 90s prefer to continue taking it, and the data shows that it continues to help prevent heart attacks in the elderly. Statins are particularly useful in people at higher risk. However, some prefer to stop taking the medicine, especially if it causes side effects or interacts with another medicine.
Dear Dr. ROACH: I have really bad side effects from Levothyroxine and Synthroid. Is Cytomel an option? Are there other medications? —PL
ANSWER: There are two main thyroid hormones (levothyroxine and triiodothyronine) used for thyroid replacement therapy. The standard is Levothyroxine, also called T4, and a very common brand name for Levothyroxine is Synthroid. T4 itself does not have much thyroid activity, but is converted in the body into the active form of the hormone triiodothyronine, also called T3. T3 is also available under the brand name Cytomel (a biologically equivalent, synthetic form of T3, also called liothyronine).
T4 is the standard treatment because it uses the body's own mechanism to produce the active hormone. T3 is rapidly absorbed and rapidly metabolized, which can cause thyroid hormone levels to fluctuate throughout the day, even when taken twice daily. Additionally, people treated with T3 had a higher risk of heart failure and stroke compared to T4 users, likely because they had too much thyroid hormone during the day.
I don't know what side effects you have. Occasionally I see that a person responds well to one manufacturer of thyroxine and I ask the pharmacist to fill the prescription with that manufacturer instead.
Dear Dr. ROACH: I'm writing about a recent answer you gave regarding sunbathing. I've heard that a short daily sun exposure (e.g. 10 minutes) is the best way to get vitamin D. What do you think about that? —CS
ANSWER: Most people don't have to worry about vitamin D. Ten minutes of exposure to the sun on your hands and face is enough to maintain your vitamin D requirements. A recent large study found no benefit from supplemental vitamin D. Therefore, I wouldn't risk getting sun damage from sunbathing, even for just 10 minutes, if your goal is to get more vitamin D.
People who should consider increasing their vitamin D intake include people with osteoporosis; people who get no sun at all (whether they live at home, live in an institution, or wear sun-protective clothing); People who cannot absorb vitamins (celiac disease patients or those undergoing bariatric surgery); and people taking medicines that speed up vitamin D metabolism (seizure medications such as carbamazepine). In these cases, a vitamin D level is indicated.
* * *
Dr. Roach regrets that he cannot respond to individual letters, but will include them in the column if possible. Readers may email questions to [email protected] or mail them to 628 Virginia Dr., Orlando, FL 32803.
(c) 2024 North America Syndicate Inc.
All rights reserved

Copy the story link