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Thursday, December 8, 2016

Drugs for cholesterol and high blood pressure actually can be cheap and work

A couple of weeks ago I started taking medicine to lower my blood pressure and another to reduce my cholesterol. This was a controversial move, given my deep distrust of the practice of medicine, when it is practiced on me, and pharmaceuticals in particular.

I know that, as a woman of 55 with an very active and healthy lifestyle, no chronic diseases and most importantly as a nonsmoker, I am at very low risk for any of the conditions that high blood pressure or high cholesterol could cause to happen. I am unlikely to have a stroke or a heart attack, develop narrowing of the arteries to my legs or develop kidney failure. The blood pressure and cholesterol levels have no effect at all on how healthy I feel. But one day, while pointing an ultrasound probe at my own neck, I saw a small plaque (a thickened area) in my left carotid artery. It was very calcified, which meant that it had been there a long while, but my carotid was not pristine. It is undeniable: I have vascular disease.

Will this lead to a stroke? Does it imply that the arteries around my heart are also affected? I don't know, and I may not find out. But I do know that taking a cholesterol lowering drug helps reduce heart attacks in patients with vascular disease around their hearts and I extrapolate that it may help reduce further changes to my carotid arteries which might lead to a stroke. My blood pressure is a bit high, and bringing blood pressure down does reduce stroke risk. I don't know that it will reduce my stroke risk, however.

So it was not entirely clear that I should take either cholesterol or high blood pressure medication. A little reduction in my very low risk may not be worth taking a medication with potentially profound side effects and associated high costs.

I decided to try the medication in order to assess whether it gave me trouble of any kind. If it did not, I might have nothing to lose. The blood pressure medication, lisinopril, has been on the market for decades. It is strongly associated with reduction in the usual complications of hypertension. Its main side effects are a nasty nagging cough and dizziness. It can also cause life threatening swelling, often of the face, but this is rare. I have had no swelling, no dizziness, and though I can feel just the tiniest bit of increased tickle in my lungs, it is hardly noticeable.

Regarding the cholesterol medication, atorvastatin (formerly known as Lipitor), it, too, has been around for a long time and has been extensively tested and found to be pretty safe and effective. It can cause muscle cramps and weakness, and I have been told by some patients that it makes them less mentally acute. It can cause gastrointestinal upset and may be associated with weight gain and a risk for diabetes. I am having no trouble so far.

As for the cost, I have had to shell out nearly $5 in copays each month, with my insurance footing about $1 of the bill. This is not expensive. This is a superb deal. I get it from my local pharmacist, not even from a mail order or Walmart's $4 plan. It is cheaper than Walmart's $4 plan! In 20 years I will have spent around $1200, plus there will be the occasional blood tests to monitor my kidney function. I checked my cholesterol after being on it shy of 2 weeks, and it was dramatically lower. I, once again, am not sure that this will translate into better health, but it is not odious at all.

The moral of this blog is that not everything is terrible in the US healthcare system. I could, and will, complain about the surrounding process that leads to people like me being on medicine at all, including issues like medicalization of the healthy and blockbuster drugs being widely adopted without adequate scrutiny, but presently I will give generic atorvastatin and lisinopril a big high five.


David said...

Did you try diet change first? When I was in my 20's, may weight started to increase from 225 lbs all the way up to 310 in my 30's. My blood pressure was typically above 140/90 and I failed the required military physical exam 4 times because of the the bp.

After changing my diet more than 20 years ago, my weight is now 185 lbs and my bp has been below 115/70 also for more than 20 years. Even before I lost most of the weight, my bp went down to these lower levels apparently just due to my dietary changes.

I eat a vegan diet with no added fat or sugar. I eat mostly low calorie density vegetables, a few fruits, with a tablespoon of ground flax seed and 2 tablespoons of raw cacao every day for their healthy fat.

Janice Boughton said...

Excellent point. My BMI is pretty low. I'm not skeletal but weight loss would be a bad idea. Your point, though is that doctors frequently bail to medication when lifestyle changes would be profoundly more effective. We do this because it takes less time and demands less from our patients, We have also absorbed the hype from the time when these drugs were a major revenue stream for their makers. But hypertension in my case is hereditary and if I choose to treat it will need drugs. The cholesterol is another question. I know I could lower it with some more radical diet changes but there is no good evidence that diet changes would halt or reverse vascular disease. The data on good fats is not convincing, though the motivation to do realty good studies is poor since a healthy diet makes no money for a drug company.

bdur said...

Janice, please keep us up to date. You have not been on either of these drugs for very long, and it would be interesting if you maintained your "self experimentation". I especially want to know when you lose your (considerable) mental acuity!

Janice Boughton said...

Another good idea. Clearly the atorvastatin had already messed with my mental functions since in the last sentence I said "...generic atorvastatin and atorvastatin..." instead of "generic atorvastatin and lisinopril" as I had intended (and just edited it to say.) No cough as yet. Not sure about GI distress since that is often a moving target. My kidneys have not yet failed, but I would only expect that if I continued to take the lisinopril when I was otherwise physically stressed. I have also not yet gotten a stroke or heart attack and muscles feel fine. I'll keep you posted.

Anonymous said...

This sounds to me like a cautionary tale regarding the risks of overscreening. You presumably knew before that you had less-than-perfect numbers, but you were not statinized, because you knew that statins for primary prevention in healthy women have a minuscule absolute benefit and are more likely to do serious harm than good. Yet as soon as you pointed that probe at your neck and saw a bit of plaque, you were made fearful and happy to accept lifelong medication - even though you no doubt also know that a huge fraction of those healthy women who don't enjoy a net benefit from statins have similar plaque.

It is like the difference between knowing intellectually that thyroid "cancer" is grotesquely overdiagnosed, and being told that you yourself have a suspicious nodule. How many people could resist the urge (and coercion) to investigate further, without wallowing in anxiety thereafter? If the answer is "hardly any", then the way to maximize your statistical health and happiness is to make sure that that wand never gets pointed at you. Ignorance really can be bliss.

With respect, if you develop numerically defined diabetes I hope you will consider discontinuing the statin and see what happens.

Janice Boughton said...

Absolutely right. I am completely not sure that this is the right path. I do believe that while ignorance is bliss, knowledge is power and there is only so far I can go with these clich├ęs. But people like me sometimes do get unexpected vascular events. They also get side effects. Using myself as an experimental animal is an active way to engage with this conundrum. I hope I don't get diabetes!

The secondary point is that some drugs which are likely good for some people are actually cheap. That is an interesting story that doesn't get much press.

warren bacon said...

Hi Janet
Since it has been 5 months would you offer an update ? I am on the cusp of possible medications similar and though very resistant to it, your post and quick movement towards these type meds. has given. me pause and re-consideration. Thanks for all the balanced insights on the various medical issues of the time
Be well ,
Warren Bacon

Janice Boughton said...

Excellent idea. The saga continues. I'll write a blog about it soon.