Statins & Secondary Prevention

[IWTASSE15]

I've been taking Atorvastatin 40 mg/day for the past 6 months subsequent to a double bypass operation. The need for surgery was identified after a single episode angina attack, but there was no actual damage to heart muscle during that episode. Since that time, I've made significant lifestyle changes (diet, exercise, weight loss, reduced stress). Based on the potential adverse side-effects of statins, I would like to discontinue the Atorvastatin, but I've been reluctant to do so since even some critics of statins (e.g., Dr. Sinatra) recommend against that if one has had a previous cardiac event. It appears that the main reason those critics continue to recommend statins for secondary prevention is due to their possible anti-inflammatory effects and also, perhaps due to some effect on stickiness of blood platelets. At the same time, to my understanding, the absolute risk reduction data and the NNTs for statins do not seem very compelling in light of the potential risk of other adverse side-effects (e.g., diabetes, muscle damage, etc.). I'd appreciate any comments on the question of statins for potential secondary prevention of future cardiac events vs. their potential for other adverse effects.

[David Staup]

I believe Dr. Graveline suggests a dose of 5 mg but you can read for yourself here:

http://www.spacedoc.com/case_low_dose_statins.html