Hello,
Thank you for your query at doctorspring.com.
1. The best treatment for his condition would be either rosuvastatin 20 mg daily or atorvastatin 40 mg daily. 5 and 10 mg are inadequate in my opinion. The goal of treatment is 50 percent reduction in ldl. Long term statin therapy may lead to clinical diabetes but the risk of having such high cholesterol is much greater than that risk of diabetes. Please discuss the same with your consulting doctor.
2. The plaque formation is a continuous process from birth. He may already have plaques but cholesterol is not the only reason for plaques. Just having high cholesterol may not be enough to develop plaques. So we cannot say with absolute confidence if he has plaques but there is a chance. Statins can reverse the plaques but not in all patients.
3. This is a manageable problem. You need not be paranoid but careful.
4.The guidelines to stop statins are not clear and I would recommend them indefinitely.
Hope this helps, please feel free to discuss further.
Regards
Dr Vivek Mahajan
DM Cardiology
Patient replied :
Dear Doctor
Thank you for the reply. It was really helpful. I have two follow up queries.
1) Since the plaque formation may or may not have occured, should we or is there any way to check and rectify the damage ? (with reference to point no.2 in the reply)
2) The patient's diet roughly consists of skinless chicken (2 days), fish (4 days), vegetables and fruits for 6 days of the week and take out food on Sundays (pizza/fast food). Is this a passable diet?
Thank you !
Hello,
Thank you for the followup .
As I mentioned the plaque formation is a continuous and natural process which is unavoidable. Conditions like high cholesterol and Diabetes accelerate it. There is no way we can directly cheque the plaque formation process and there is no need either. Instead we cheque markers like cholesterol levels, blood sugar, blood pressure etc. He can have an annual physical examination & blood tests in addition to the cholesterol cheques recommended by your Doctor.
The diet plan looks healthy, but a lot depends on his current weight and daily activity. If your husband is obese weight loss takes highest priority. Moderate aerobic exercise alt-east 40 minutes a day / 5 days a week is must (unless there is other complicating illness). Reducing take outs / processed foods / fried food obviously is the smart choice, but it might not be always practical. That is why exercise and medications are equally important.
There are three cornerstones for treatment - Drugs, Diet and Exercise. ALL of them are important. Do continue the medications. The current diet plan looks neat, but when possible cut down on processed foods / takeouts. Do aerobic exercise 5 days / week.
If he is obese / overweight let me know, the approach changes a little. (You can calculate his BMI - or you can provide his height and weight).
Hope this helps
Feel free to ask followups
This consult will be open. In future if you have queries you can just ask a followup.
Regards
Dr.VM
DM Cardiology