Tuesday, April 01, 2008

Meds & Me

I started taking statin drugs to lower my cholesterol nearly 12 years ago – first Pravachol and then Lipitor. They worked and my numbers went from high to average or better. Then, two years ago I added Zetia. It would, my cardiologist said, lower my LDL (the ‘bad’ cholesterol) and lessen the possibility that bad cardiovascular things would happen.

He was right about the numbers. My pre-Zetia LDL was around 100; two months ago it was 63. Here’s where it begins to get confusing. A few years ago the conventional medical wisdom was that an LDL reading of 62-160 was normal. Now they say it should be 100 or lower. So even by today’s standards my pre-Zetia LDL wasn’t bad. But, hey, if lower is better and I’m not suffering from any side effects, why question whether I should continue taking Zetia?

No reason – until I began reading that Zetia may not be all the hype said it was. Turns out that a research study buried for nearly two years by the drug makers of Vytorin (a combination of Zocor and Zetia) showed that the drug did indeed reduce LDL but didn’t have any impact on plaque buildup. The key evidence, does it reduce heart attacks and strokes, won’t be known until 2012.

Not surprisingly, these revelations led to a controversy in the medical and pharmaceutical communities and confusion for the average user, i.e., me. Since the studies weren’t totally conclusive about the positives and negatives surrounding Zetia I was left uncertain about whether I should continue taking the drug.

Here’s where I learned something about myself. If I had been wired up differently I might have dropped Zetia at the first sign there was an issue about it. I had my annual cardiology checkup soon after that so I figured I’d ask the doctor, which I did. He did not have a firm recommendation since there was still so much unknown on the subject. I could continue with Zetia and Lipitor as is. I could drop Zetia and up the Lipitor dosage. I could drop Zetia and leave Lipitor unchanged. He did suggest that if I changed my meds I do a blood test in a few months to check on the impact it was having.

On the one hand I was telling myself, “If I’m not doing any harm and there’s a chance I’m doing some good, maybe I should keep things as they are.” On the other hand I was telling myself, “Why continue taking something that hasn’t proved to be beneficial? I should stop the Zetia.”

I usually don’t delay making decisions. I could more often be accused of making decisions too hastily. So my indecision was a deviation from my usual pattern. I’d be seeing my primary care physician soon and would ask her. In the meantime I’d keep taking both Lipitor and Zetia. I saw her, asked, and got about the same answer the cardiologist had given me. No real help here.

It is now time to refill my Zetia prescription – or not. The timing is good in that this week the controversy has ignited again and this time the cardiology community has taken a firmer stand. Don’t prescribe Zetia unless you, the doctor, feel it is absolutely necessary.

I’m now convinced. I won’t refill my prescription. What I will do is remember what I’ve seen about my behavior. I’ll take a risk even if there is only a small chance that the risk will pay off. I’d rather do that than play it safe and miss the chance for a breakthrough.


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