Both the commercials and the website state that “Lipitor has not been shown to prevent heart attacks or heart disease.” So what is the point in taking it? It doesn’t seem to me that having a nice low cholesterol reading would be worth much in and of itself. Perhaps a doc will come along and explain it to me…
IANAD, but I have been taken “statins” for 15 years in order to control my cholesterol levels. If I didn’t take Lipitor my cholesterol would be about 250. Since I started taking it my level has not gone above 170. High cholesterol is a risk factor for heart disease. Why wouldn’t you take it (if you needed to lower your cholesterol)?
Lipitor is too new a drug to show whether less people will suffer heart attacks or end up getting heart disease, but it does show that it lowers total cholesterol in most people, so it is assumed it will be of benefit.
Keeps the Lipitor people happy.
My Doc wanted to put me on it due to my family history and some really adverse blood numbers. (anecdotal) From what I’ve seen, if you are predisposed to arterial plaque (which is how cholesterol gets you I guess) there’s not a lot you can do about it except maybe clone yourself and shedule a heart transplant in 15-20 years…but that kind of planning would freak someone out. There is some evidence that vitamin & niacin supps can be just as effective.
Don’t follow my advise though, I ain’t no doktor. Lipitor is great if you like abdominal cramps and daily drugs that hopefully won’t interact with something you REALLY need later on.
From here:
“After age 50 years there is no increased overall mortality with either high or low serum cholesterol levels”
So I’m still waiting for a good answer (Unless of course you’re 30 and have really high cholesterol. According to the Framingham study, LOW cholesterol levels were more strongly associated with mortality in people over 50. Hmmmm…
Well, let’s see. One patient, first heart attack age 39, Total Cholesterol 402, LDL 280, HDL29. Bad mojo there. Stents placed, Lipitor maximized.
Later: Total cholesterol 169, HDL 44, LDL 79. Regression of stenosis seen on cardiac catheterization. 8 Years go by so far, no more heart attacks.
If you have a truly BAD cholesterol profile, Lipitor (atorvastatin) will improve it. A body of evidence is accumulating which shows that not only can the med decrease the rate of coronary artery stenosis increase, but can actually reverse it.
The statins can make quite a difference in the right patient. But one size doesn’t fit all. I had one colleague put an 80 year old on a statin because “His cholesterol is too high, it’s 245!” I told my colleague that the patient was at greater risk from his doctor than from his cholesterol.
Patient selection is everything!
I think the answer that best fits the OP’s question has to do with so-called ‘class effects’ (or lack of them).
As mentioned by dolphinboy, Lipitor is just one of a class of drugs known as ‘statins’. Other members of this class (eg. Pravachol = pravastatin, Zocor = simvastatin) have been shown to reduce heart disease. So, is this benefit specific to only certain statin medicines or to all members of the class?
A purist might insist that for any specific drug of a class to be considered effective for condition X, it must specifically have been shown to be of benefit for X before it can be accepted as a treatment for condition X, even if other members of the same class have been shown to be of benefit for X. This would be very expensive and laborious, but possibly justifiable on scientific grounds. On the other hand, if we believe we know the mechanism of how a class of drugs work, and if all previous members of that class have been shown to be effective, we are probably safe in assuming that late-comers to the class will also work. Certainly, this concept often underlies the development and use of “me too” drugs which appear on the scene later but at reduced price.
The medical literature is filled with the problem of class effect versus specific drug effect. Examples of drug classes where the beneficial effect seems to be a property of the entire class and not just specific drugs in the class include beta-blockers (eg. atenolol, metoprolol, etc) and ACE-inhibitors (eg. enalapril, ramipril, etc). Conversely, the class of drugs known as calcium channel blockers (eg. nifedipine, diltiazem, amlodipine, etc) seems truly heterogeneous in its benefits/problems.
However, there are unequivocal examples of toxicity of just particular drugs of a class, where the class itself has otherwise been shown to be safe. An old example is the beta-blocker practolol which caused serious eye problems and another, more recent, example is the statin known as cerivastatin which led to muscle damage and kidney failure.
My personal preference is to try to use those drugs of a class which have specifically, themselves, been shown to be of benefit (unless there are compelling balancing reasons to offset this principle such as issues of patient compliance, safety, or major cost differential). Indeed, I suspect that there may be subtle differences among the drugs of a class which might involve not just their effectiveness and safety, but also their mechanism(s) of actions. It is distinctly possible, for example, that only certain statins have abilities to prevent atherosclerosis beyond their effect to lower cholesterol. But that is just MHO.
Has any particular statin been shown to be more effective than the others?
Here’s a layman’s analogy:
For years the tobacco companies made the contention that there was no “proven” direct link between smoking and cancer (apparantly they were the only ones that had the “proof” and they were covering it up, but that’s another story). Nevermind that a very high percentage of people affected with lung cancer were smokers, there was still no “proven” direct link.
Similar situation with cholesterol and heart attacks. While it hasn’t been “proven” that high cholesterol, in and of itself, causes heart attacks, it is obvious to the medical profession that an overwhelming number of people that suffer heart attacks have high cholesterol.
So, even before the link between smoking and lung cancer was proven the medical profession was advising people to quit smoking. In the same sense, the medical profession is advising people to lower their cholesterol to avoid heart disease.
I’m getting a bit off topic and I apolgize up front, but who knows of any natural remedies for high cholesterol/leading to an MI? I had heard of garlic and use it quite faithfully. One parent died of a heart attack at age 45 and I would dearly love to avoid the same fate.
As for Lipitor. I don’t know. Sometimes the drug companies pedal these drugs despite their side affects. I don’t know which ones Lipitor may have.
Sometimes the cure is worse than the affliction and I understand that physicians get perks for prescribing these drugs. Is that true. I don’t know and would love to hear from an authority on the subject.
IANAD, but I do take a 10MG Lipitor pill each day under doctor’s orders…
Lipitor is a prescription medication (where I live, anyway - your mileage may vary), so you can’t just run out and buy it. When I started taking it, my doctor made me come in every three months for blood tests (which he still makes me do, just less frequently) checking for liver damage. He told me that’s the main side-effect of that type of medication and that’s what he was guarding against.
If you believe that your physician is capable of prescribing medication that will hurt you more than it will help you, then I strongly suggest that you get another physician. After all, wouldn’t you do that if you thought the same about your car mechanic?
I take 80 mg Lipitor daily and quite a few other meds. Before I started taking the lipitor my total cholesterol was 480. Now it is 270. Still high but much better. It has been as low as 220 but I had been off the lipitor for 9 months to have a baby so my cholesterol went up over that time.
I take this because I am only 31 right now and I’ve had cholesterol problems since I was a teenager. I and my doctors ( my PCP and my Nephrologist ) have agreed that this is the best option for me to keep me healthy. I take bloodwork every 3-6 months and they keep track of medicines I take, possible interactions, and the risk/benefit ratio.
If I thought for one second that they prescribed my medicines simply for the perks of the drug companies I would seek a new doctor.
robby asked:
Well, it depends on what groups of patients, and under what circumstances, you’re talking about.
Lipitor (atorvastatin) has been shown to prevent “cardiac events” in patients who recently experienced serious angina (MIRACL trial) and people with high blood pressure (ASCOT-LLA trial).
Pravastatin (Pravachol) has been shown to prevent first heart attacks in people who’ve never had one (WOSCOP trial), and also to prevent recurrent ones in those who already have (CARE trial).
Simvastatin (Zocor) has been shown to prevent second heart attacks in those people who’ve already had one (4S trial), and to prevent first heart attacks in high risk patients such as diabetics (HPS trial).
Once more, most people prescribing these drugs would probably attribute these reductions in cardiac events to a class effect and not pay too much attention to which particular statin is used. Purists would insist on using only pravastatin, simvastatin, or atorvastatin and not other statins*. I like pravastatin because of its excellent safety profile.
[sub][sup]*I will depend on Qadgop to confirm that I’m right and that only the above three statins have been shown to reduce cardiac events (and not just achieve “surrogate end points” such as lower cholesterol, decreased intimal thickness, etc).[/sup][/sub]
From today’s JAMA - in patients who *already have * coronary disease, Lipitor appears more effective than Pravastatin.
So, going back to the OP, there does indeed seem to be a “point in taking Lipitor”.
Which is why I’m sticking with my Lipitor even tho my insurance no longer considers it a preferred drug. They want to put me on pravastatin, even after my stenting!
To keep me employed.
Bmalion
Pfizer Corporate Travel Consultant
Got any cool Lipitor pens? 
My Lipitor rep has not stopped by my office in ages!!! What’s up with that??
Now that I think of it, the Viagra guy hasn’t been by in quite a while either.
In fact, I’ve never seen a drug rep at my current office. Hmmmmmm…
Probably couldn’t make it through security.
OK, not a doctor, don’t even play one on TV, so if you try this and die don’t come crying to me. I started out with a total cholesterol of 215 and an HDL of 54, so the HDL/Total ratio of 4.0. The 4.0 is the maximum ratio recommended for caronary health.
After two years on Atkins my total cholesterol went down to 191, and my HDL went up to 76 new ratio 2.5.
I cook using only butter or olive oil, no trans fats. I eat red meat very regularly. I do use a metric buttload of garlic, but primarily because I like the taste, and I’ve always done that, so it can’t have caused the improvement.
Anecdotal, but I’ve had plenty of people tell me the same thing. Course, the dead ones aren’t bragging about it, so who knows?