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In regards to fish oil consumption. chesk all that apply
I use fish oil capsules 2
I do not use fish oil capsules 9
I take it for my joint pains or arthritis 0
I take it for general health 0
I have had a heart attack or stroke and want to prevent another 0
I have never had a heart attack or stroke but would like to prevent one 0
My doctor recommended that I take fish oil capsules 1
I decided on my own to take fish oil capsules 2
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JUst a quick poll. WHo here uses FIsh Oil Capsules and for what indication are you taking them
Posted: 20 March 2014 02:23 AM   [ Ignore ]   [ # 31 ]
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I’ve been taking high quality (pharmaceutical grade) fish oil for years.  Not too many years ago one of my physicians gave me a prescription for Lovaza, which provides higher doses in fewer capsules.  I definitely notice a difference when I take them regularly and over the years that I have taken them, they have decreased both my cholesterol and triglycerides…. with no other lifestyle changes made.  I was prescribed a statin, but never took it due to the documented side effects - and it seems, I did not need it after all.  My brother was once prescribed statins as well, I encouraged him to ensure he was taking CoQ10, which most physicians do not advise patients to take when using statins… he choose to stop taking the statins and modify his diet and other contributing factors he could control.  Turns out it was a good decision.

macgyver - 03 March 2014 01:20 PM

Fish oil capsules a pretty commonly used supplement and many physicians recommend them to their patients although I find even among doctors there is some confusion about the appropriate indications for their use. I’m curious how many forum readers take Fish Oil supplements, what they are being used for and whether they are being taken under the advice of a physician or self prescribed. Thanks

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Posted: 20 March 2014 02:31 AM   [ Ignore ]   [ # 32 ]
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macgyver - 04 March 2014 06:14 AM

I am not a big fan of using medications unless there is a good reason and a clear benefit but in this area I think there is no doubt that the benefits of statins in the right patients are significant. Fish oil on the other hand has not been shown to have such benefits. Here are the new guidelines for cholesterol treatment which are based more on cardiac risk than absolute cholesterol levels now.

I can agree with you on your above statement.  The problem I find is that statins are routinely prescribed without adhering to the criteria you list below - neither myself nor my brother had any of the risks listed.  smirk  Well, we both had LDLs slightly greater than 190mg/dL.

macgyver - 04 March 2014 06:14 AM


“The four major primary- and secondary-prevention patient groups who should be treated with statins were identified on the basis of randomized, controlled clinical trials showing that the benefit of treatment outweighed the risk of adverse events. The four treatment groups include:

  Individuals with clinical atherosclerotic cardiovascular disease.

  Individuals with LDL-cholesterol levels >190 mg/dL, such as those with familial hypercholesterolemia.

  Individuals with diabetes aged 40 to 75 years old with LDL-cholesterol levels between 70 and 189 mg/dL and without evidence of atherosclerotic cardiovascular disease.

  Individuals without evidence of cardiovascular disease or diabetes but who have LDL-cholesterol levels between 70 and 189 mg/dL and a 10-year risk of atherosclerotic cardiovascular disease >7.5%.”


Source:http://www.medscape.com/viewarticle/814152

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Posted: 20 March 2014 02:47 AM   [ Ignore ]   [ # 33 ]
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Hi there, mckenzievmd!

Thank you for providing a link to your source.  I did a bit more reading on the SELECT Clinical Trial, which was actually looking at the effects of Vitamin E and Selenium supplementation in preventing Prostate Cancer.  In review of the methods of the trial, there are a few problems; first however, we all know that correlation does not = causation.  The other problems:

1.  Participants were not given supplements of fish oil as part of the trial, so there is no way to know the source of the long-chain fatty acids, i.e., from diet or supplements.  Though, the majority of participants indicated they did not take fish oil supplements.
3.  The results strangely enough found that those participants with the highest percentage of trans fatty acids in their bloodstream had a lowered risk of Prostate Cancer!  Quite questionable.
4.  What about other variables in the participants, those who were smokers, regularly drank more than moderate amounts of alcohol or those who were overweight and obese… how did these factors correlate with the risks of Prostate Cancer and the percentage of the Omega-3 fatty acids in the participants’ blood?
5.  They reported the fatty acids in terms of percentages, rather than absolute values, which can be misleading since it ignores real differences. 

Well, I would like to know more about your thoughts on this study.

mckenzievmd - 04 March 2014 09:50 AM

Tim,

The other thing to realize is that anything you take which has a beneficial effect on your health can also have risks. For some reason, people assume medical use of supplements like fish oil is safe because normal dietary intake of fish is safe, but that simply isn’t true. For example, fish oils have been linked to an increase risk of prostate cancer. Choosing one therapy over another is a matter of evaluating the current best evidence about risks and benefits, so comparing statins to fish oils means comparing the evidence of risks and benefits for each, not assuming one is safer because it is a supplement and the other more danegrous because it is a “drug.”

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Posted: 20 March 2014 04:52 AM   [ Ignore ]   [ # 34 ]
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RubyWoo - 20 March 2014 02:17 AM

If reducing cholesterol is not the objective in prevention of heart disease (and thus heart attacks), then how would statins help, as they are cholesterol lowering medications (and triglycerides as well)? 

 

Lowering cholesterol is only useful if it reduces the risk of health problems like heart attacks and strokes. While statins do lower cholesterol it dos not appear to be the primary mechanism by which they reduce the risk of these diseases. Statins have the ability to reduce vascular inflammation and this may be more important than lowering cholesterol. There are a number of other types of medications that are capable of lowering cholesterol and none of them reduce heart attack risk to the same degree as statins. As stated previously Omega 3 fatty acids can indeed have a beneficial effect on the lipid profile and yet they have not been shown to have positive effect on outcomes like heart attack and stroke.

[ Edited: 20 March 2014 06:00 AM by macgyver ]
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Posted: 20 March 2014 04:59 AM   [ Ignore ]   [ # 35 ]
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RubyWoo - 20 March 2014 02:23 AM

Not too many years ago one of my physicians gave me a prescription for Lovaza, which provides higher doses in fewer capsules.  I definitely notice a difference when I take them regularly and over the years that I have taken them, they have decreased both my cholesterol and triglycerides…. with no other lifestyle changes made.  I was prescribed a statin, but never took it due to the documented side effects - and it seems, I did not need it after all.  My brother was once prescribed statins as well, I encouraged him to ensure he was taking CoQ10, which most physicians do not advise patients to take when using statins… he choose to stop taking the statins and modify his diet and other contributing factors he could control.  Turns out it was a good decision.

I am not sure what you mean when you say you “notice a difference ” with Lovaza but from a therapeutic standpoint Lovaza has no advantage over other fish oil products. It is a more pure product but has not been shown to reduce heart attacks or strokes. The next time you see the Lovaza commercial on TV ( the one in the underwater lab) pay attention to the disclaimer at the end which confirms that lovaza has not been shown to reduce heart attacks or strokes.

CoQ10 IS advised by some doctors when prescribing statins but it is done out of ignorance of the literature. This has been studied and CoQ10 has not been found to be beneficial in reducing the cases of muscle pain caused sometimes by statins.

I can’t emphasize enough that the worries about statin side effects are unfounded. Medication should never be used if there isnt a good reason to do so but statins are extremely safe to use and can have significant effects on reduction in cardiovascular disease in the correct groups of people. I need to add that you DO meet the criteria for statin treatment according to the limited information you have given. According to the prior recommendations which were only recently changed, anyone with an LDL over 160 should be treated, but under the new criteria the cut off is 190 and you admit that your LDL was over 190. In addition you may meet the cardiac risk indication if your calculated risk is more than 7.5%, but you wold have to use the calculator yourself since it requires more data than you have given here to do the calculation.

Here is the link to the calculator: https://www.heart.org/gglRisk/main_en_US.html

[ Edited: 20 March 2014 06:02 AM by macgyver ]
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Posted: 20 March 2014 09:24 AM   [ Ignore ]   [ # 36 ]
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macgyver - 20 March 2014 04:59 AM
RubyWoo - 20 March 2014 02:23 AM

Not too many years ago one of my physicians gave me a prescription for Lovaza, which provides higher doses in fewer capsules.  I definitely notice a difference when I take them regularly and over the years that I have taken them, they have decreased both my cholesterol and triglycerides…. with no other lifestyle changes made.  I was prescribed a statin, but never took it due to the documented side effects - and it seems, I did not need it after all.  My brother was once prescribed statins as well, I encouraged him to ensure he was taking CoQ10, which most physicians do not advise patients to take when using statins… he choose to stop taking the statins and modify his diet and other contributing factors he could control.  Turns out it was a good decision.

I am not sure what you mean when you say you “notice a difference ” with Lovaza but from a therapeutic standpoint Lovaza has no advantage over other fish oil products. It is a more pure product but has not been shown to reduce heart attacks or strokes. The next time you see the Lovaza commercial on TV ( the one in the underwater lab) pay attention to the disclaimer at the end which confirms that lovaza has not been shown to reduce heart attacks or strokes.

CoQ10 IS advised by some doctors when prescribing statins but it is done out of ignorance of the literature. This has been studied and CoQ10 has not been found to be beneficial in reducing the cases of muscle pain caused sometimes by statins.

I can’t emphasize enough that the worries about statin side effects are unfounded. Medication should never be used if there isnt a good reason to do so but statins are extremely safe to use and can have significant effects on reduction in cardiovascular disease in the correct groups of people. I need to add that you DO meet the criteria for statin treatment according to the limited information you have given. According to the prior recommendations which were only recently changed, anyone with an LDL over 160 should be treated, but under the new criteria the cut off is 190 and you admit that your LDL was over 190. In addition you may meet the cardiac risk indication if your calculated risk is more than 7.5%, but you wold have to use the calculator yourself since it requires more data than you have given here to do the calculation.

Here is the link to the calculator: https://www.heart.org/gglRisk/main_en_US.html


You wrote: “I can’t emphasize enough that the worries about statin side effects are unfounded.”

But what if the side effects are debilitating, as they were for me? I guess I have two choices: suffer the debilitating side effects, even if it makes life hardly worth living, or die.

I’m not sure that such a concern is “unfounded,” especially when the “cure” may be worse than the disease.

Lois

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Posted: 20 March 2014 09:37 AM   [ Ignore ]   [ # 37 ]
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Lois - 20 March 2014 09:24 AM

You wrote: “I can’t emphasize enough that the worries about statin side effects are unfounded.”

But what if the side effects are debilitating, as they were for me? I guess I have two choices: suffer the debilitating side effects, even if it makes life hardly worth living, or die.

I’m not sure that such a concern is “unfounded,” especially when the “cure” may be worse than the disease.

Lois

That wasn’t what I meant to convey Lois. Most people who are afraid to take statins are afraid because they have heard incorrectly that it could damage their liver or kidneys. These worries are generally unfounded. The myalgias or muscle aches you had are an issue but not a dangerous problem except in very rare cases and they are reversible when the medication is stopped so while it may prevent some people from taking the medication it is not a justification for someone not to try the medication since most people do not get this side effect.

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Posted: 20 March 2014 10:11 AM   [ Ignore ]   [ # 38 ]
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I certainly agree with Lois.  I’ve been prescribed five different statins and each causes severe muscle pains.  When the first and worst of them, after 40 mg. Lipator, hit, thank goodness my dentist had prescribed a few codeine pills a few years ago.  I limped to the freezer, took out one of the remaining three, chewed it then went to bed until it got back to a minor pain.  So, Macgyver, do you think my doctor should prescribe a combination statin/codeine pill for me? smile

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Posted: 20 March 2014 12:16 PM   [ Ignore ]   [ # 39 ]
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Occam. - 20 March 2014 10:11 AM

I certainly agree with Lois.  I’ve been prescribed five different statins and each causes severe muscle pains.  When the first and worst of them, after 40 mg. Lipator, hit, thank goodness my dentist had prescribed a few codeine pills a few years ago.  I limped to the freezer, took out one of the remaining three, chewed it then went to bed until it got back to a minor pain.  So, Macgyver, do you think my doctor should prescribe a combination statin/codeine pill for me? smile

Occam

Very funny but no. Its clear that for some reason a minority of people are unable to take statins due to statin induced myalgias. As I stated above, this is a problematic side effect but in most cases not a dangerous one. Its certainly not a reason to avoid trying a statin, but if pain persists the drug should be stopped because in very rare cases a serious condition known as rhabdomyolysis can occur. Although your question was obviously asked tongue in cheek no one should take narcotic pain meds to counter severe muscle pain from a statin.

One thing i need to point out. I am not saying this applies to either Lois or Occam but in order to help everyone understand the true frequency of the muscle ache problem its important to realize that the majority of people who have muscle pains ON statins do not have muscle pains FROM the statin. What I mean is that most of the pains people get when taking a statin are due to the Nocebo effect. They are the normal aches and pains we all get. The problem looks worse than it is because the average person who is on a statin is older and more likely to have a higher BMI. On average this group has more muscle pains. Additionally many statin users have heard rumors about the muscle pains and are looking for them from the day they start the drug. When you look at the initial studies done on statins patents on the drug due indeed have a higher rate of muscle pains than those on placebo but the interesting thing is that the placebo group still had muscle pains at a rate that was only 25% lower than the statin treated group. So 75% of all the people who have muscle pains on statins are having them for some reason not related to the drug at all. If you have 100 friends who took statins and 8 developed muscle pains only 2 of them is likely due to the drug ( The actual combined incidence of statin induced muscle pain and rhabdomyolysis is about 200 per 100,000 patients). The rest may have pains but its not from the drug although they will most likely attribute it to the drug and pass this information along to others making the problem look far more common than it is.

[ Edited: 20 March 2014 12:19 PM by macgyver ]
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Posted: 20 March 2014 12:57 PM   [ Ignore ]   [ # 40 ]
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Mac are you serious?  Normal background muscle pain?
I’ve never heard of such a thing.  I would think any muscle pain could be traced to a cause.
What are the normal aches and pains we all get? Nobody should have aches and pains unless they exerted themselves strenuously from work or sports. Or they could be caused from contusion.

Otherwise, I would tend to believe that these people claiming aches in their muscles would be from the drug.
Kind of an Occam’s Razor thing.  Or just plain knowing one’s body and able to determine basic cause and effect.

Your willingness to staunchly defend pharmaceuticals is comical to me. It’s so overt.

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Posted: 20 March 2014 03:20 PM   [ Ignore ]   [ # 41 ]
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I have no desire to defend the pharmaceutical industry. My intent is to defend reason regardless of which side of the argument that puts me on. I have no financial interest in the pharma industry. Your barking up the wrong tree.

Vyazma I know you’re not 18 years old so I am not sure why you wold be so surprised that most adults get aches and pains from time to time. I’m in my fifties and I get them and most people over 50 that I know also get them from time to time. Ligaments and tendons get significantly less elastic as we get older so they even daily housework and yard work can lead to minor aches and pains that can show up days later and last for long periods of time. Even turning a joint too quickly or making a sudden grab can strain a ligament. You would be hard pressed to find many 50 plus individuals who dont get some muscle soreness periodically.

Again, I support my argument about the nocebo affect with RCT’s comparing these drugs to placebo that showed patients on placebo had muscle aches during the trial period at a rate that was about 75% of that seen in the drug treated group so we can assume that a similar rate occurs in the real world.

I have found among patients who are convinced the medication is causing pains that when I carefully inquire about the details there are many aspects of their pain that does not fit the theory that their pain is due to the medication. Often times they are referring to joint pains not muscle pains and joint pains have never been associated with statins. Many patients dont know the difference. On other occasions when we do a trial off the medication the pain does not go away or it waxes and wanes regardless of whether they are on medication or not.

As I have already stated there is a known phenomena whereby statins can cause muscle pains in a small percentage of patients but controlled trials have consistently shown that muscle pains occur in both placebo and treated patients and that 3/4 of the pains that the drug treated patients are experiencing are not drug related.

[ Edited: 20 March 2014 03:24 PM by macgyver ]
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Posted: 20 March 2014 05:40 PM   [ Ignore ]   [ # 42 ]
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Quoting Macgyver:

Although your question was obviously asked tongue in cheek no one should take narcotic pain meds to counter severe muscle pain from a statin.

You’re right that I was joking, and as a rule one shouldn’t take codeine along with statins, however, I had had no history of severe cramping (even at 80 as I was then), and I had no idea that it was the statin causing the pain.  At that moment the logical action was to take a strong pain killer.  Had it not abated, I’d have called for help.  I then realized I had just started on the 40 mg. regimen, so I stopped for a few days, the pain didn’t recur.  I started again and got zapped so I told my cardiologist.  I consider my behavior rational and taking the codeine that one time not an error.

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Posted: 20 March 2014 07:12 PM   [ Ignore ]   [ # 43 ]
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Occam. - 20 March 2014 05:40 PM

Quoting Macgyver:

Although your question was obviously asked tongue in cheek no one should take narcotic pain meds to counter severe muscle pain from a statin.

You’re right that I was joking, and as a rule one shouldn’t take codeine along with statins, however, I had had no history of severe cramping (even at 80 as I was then), and I had no idea that it was the statin causing the pain.  At that moment the logical action was to take a strong pain killer.  Had it not abated, I’d have called for help.  I then realized I had just started on the 40 mg. regimen, so I stopped for a few days, the pain didn’t recur.  I started again and got zapped so I told my cardiologist.  I consider my behavior rational and taking the codeine that one time not an error.

Occam

It certainly sounds like your symptoms and Lois’ symptoms ( from a prior discussion) were likely statin induced myopathy and your actions were reasonable.

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Posted: 21 March 2014 01:50 AM   [ Ignore ]   [ # 44 ]
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Hello, macgyver,

You are incorrect in your statement that lowering cholesterol is not the primary mechanism by which statins are proposed to lower the incidence of CVD.  Check Wikipedia and any of the statin websites.  This is from the Lipitor website:

How Lipitor Works:

“Statins lower cholesterol in the body by blocking an enzyme in the liver. The body uses this enzyme to make cholesterol. When less cholesterol is made, the liver uses more of it from the blood. This results in lower levels of cholesterol in the blood.

Along with a low-fat diet, LIPITOR is clinically proven to lower LDL (“bad”) cholesterol by 39%-60% (average effect depending on dose).

If you have high cholesterol, it’s important you be proactive about your health. Having high cholesterol levels can make you more likely to have a heart attack. Talk to your doctor about your risk and if LIPITOR is right for you.

INDICATION:
LIPITOR┬« (atorvastatin calcium) tablets are a prescription medicine that is used along with a low-fat diet. It lowers the LDL (“bad”) cholesterol and triglycerides in your blood. It can raise your HDL (“good”) cholesterol as well. LIPITOR can lower the risk for heart attack, stroke, certain types of heart surgery, and chest pain in patients who have heart disease or risk factors for heart disease such as age, smoking, high blood pressure, low HDL, or family history of early heart disease.

LIPITOR┬« (atorvastatin calcium) tablets can lower the risk for heart attack or stroke in patients with diabetes and risk factors such as diabetic eye or kidney problems, smoking, or high blood pressure.”

Reduction in vascular inflammation is a minor part of the statin mechanism of action and thus, confirms that statins are primarily used (and effective) in those who have established CVD, not as a primary preventative measure as you have previously stated.

Whether Omega-3 fatty acids have a positive effect on outcomes of heart attack and stroke, is not relevant for me, as I have not had either a heart attack or stroke, and Omega-3 FAs provide other healthy benefits that make them an important supplement to my less than ideal diet.

macgyver - 20 March 2014 04:52 AM

Lowering cholesterol is only useful if it reduces the risk of health problems like heart attacks and strokes. While statins do lower cholesterol it dos not appear to be the primary mechanism by which they reduce the risk of these diseases. Statins have the ability to reduce vascular inflammation and this may be more important than lowering cholesterol. There are a number of other types of medications that are capable of lowering cholesterol and none of them reduce heart attack risk to the same degree as statins. As stated previously Omega 3 fatty acids can indeed have a beneficial effect on the lipid profile and yet they have not been shown to have positive effect on outcomes like heart attack and stroke.

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Posted: 21 March 2014 02:05 AM   [ Ignore ]   [ # 45 ]
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Hello macgyver,

I don’t take Lovaza (and previously other brands of pharmaceutical grade fish oil) for the cardiovascular benefit.  As far as my circumstances go, there are other issues that would be more of a benefit to me even if Lovaza was ‘proven’ to lower CVD risk.  Lovaza has advantages over many other fish oil products in that it is highly concentrated, thus you take fewer capsules to obtain the same amount.  I take high doses of fish oil and with other brands, I would need to take many times the number of capsules or take them more frequently throughout the day.  As I use other supplements, it’s an advantage to me to minimize the number of fish oil capsules I need to take to obtain the desired results.

macgyver - 20 March 2014 04:59 AM

I am not sure what you mean when you say you “notice a difference ” with Lovaza but from a therapeutic standpoint Lovaza has no advantage over other fish oil products. It is a more pure product but has not been shown to reduce heart attacks or strokes.

Could be, by some how the physician who I went to (at a well respected university health center) did not think to advise me to take CoQ10 along with the statin she prescribed.  This decreased my confidence in her overall knowledge of what she was prescribing to me.  My brother’s physician also neglected to mention the importance of taking CoQ10 along with his statin.  Anecdotal perhaps, but it was enough for me to remember that it’s important for consumers to always be well-informed of the product(s) being ‘sold’ to them - especially patient consumers.

macgyver - 20 March 2014 04:59 AM

CoQ10 IS advised by some doctors when prescribing statins but it is done out of ignorance of the literature. This has been studied and CoQ10 has not been found to be beneficial in reducing the cases of muscle pain caused sometimes by statins.

Appreciate your seeming concern for my well-being - but you are correct, you are missing critical information in forming your assessment.  I’m happy I chose not to take the statins and until I have established cardiovascular disease, I will not take it. 

macgyver - 20 March 2014 04:59 AM

I can’t emphasize enough that the worries about statin side effects are unfounded. Medication should never be used if there isnt a good reason to do so but statins are extremely safe to use and can have significant effects on reduction in cardiovascular disease in the correct groups of people. I need to add that you DO meet the criteria for statin treatment according to the limited information you have given. According to the prior recommendations which were only recently changed, anyone with an LDL over 160 should be treated, but under the new criteria the cut off is 190 and you admit that your LDL was over 190. In addition you may meet the cardiac risk indication if your calculated risk is more than 7.5%, but you wold have to use the calculator yourself since it requires more data than you have given here to do the calculation.

Here is the link to the calculator: https://www.heart.org/gglRisk/main_en_US.html

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