December 18, 2014

My New Docs on My Meds: Blood Pressure, Yes. Cholesterol, No.

"Less is more" is one of my mantras. So is "anything worth doing is worth overdoing." I've spent much of my life bouncing back and forth between these mantras.

Last year, "less is more" drove me to ditch both my blood pressure (BP) and cholesterol (statins) meds. In both cases, I seized upon new recommendations from some medical authorities that the +75 elderly without coronary issues could stop taking these medications.

During the past month, I've talked with more doctors than I'd normally see in a year. I wanted a new internist who was also a geriatrician. I've also been consulting a variety of doctors about my recent dual blood pressure problem -- spikes that carry stroke risk, and sudden drops that bring the risk of falling.  

Blood Pressure Meds
In light of my two BP problems, all doctors agreed I needed to resume the BP meds. All but one of them had heard of the new recommendation aganst using statins for the heart-healthy +75 as well as the new use of 150/90 as thesuggested borderline between low and high blood pressure for this group. Nonetheless, they felt those new perameters should be applied cautiously, on a case-by-case basis. And they agreed my case called for resuming a blood pressure med

So,  as of December 18, I'm taking a very low 2.5mg dose of lisinopril, an ace-inhibitor that relaxes the blood vessels. So far, so good.

Statins for Cholesterol
The docs concurred here -- I should continue my statin-free regimen. Statins are the subject of hot debates these days, especially for seniors with high cholesterol but no indication of heart disease.

Scant clinical evidence exists to support the notion that otherwise-healthy seniors 70+ should take statins. And statin use has been linked to a variety of issues, including muscle aches, liver toxicity, gastrointestinal distress, impaired memory, diabetes, and cancer.

But, in spite of evidence linking statins with worrisome health issues, there's also evidence that taking statins has positive results. The December 2014 issue of the Harvard Health Letter reports on a recent study involving over 24,000 patients. The conclusion? People taking statins had a 39 percent lower risk of stroke than those not on the drugs. Compared to study participants taking placebos, the stroke risk for people on statins was 24 percent lower.

A consensus may be emerging on the statin issue for healthy seniors -- prescribe these meds on a case-by-case basis. One test being touted to help doctors make their recommendations is the Framingham heart study score , which assesses death-by-heart-attack risk within the next ten years.

Here's a possible guideline that's been suggested for use in the new case-by-case approach. According to the Harvard letter, statins are appropriate only for people whose heart attack or stroke risk within ten years is 7.5 percent above the mean.

For more on this debate and background on my decision to ditch the statins, see

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