Simply because lovastatin is the cheapest, and the only statin MO in KKM can prescribe (other statins need specialist prescription)

This post has been edited by hypermax: Dec 17 2012, 08:56 PM

yeah cheaper. statins mostly differ by their potency.

For your info, some consultants even routinely prescribed statin for all type 2 diabetic patients above the age of 40 regardless of baseline lipid profile.

atorva should be more potent, rosuva too, compared to simva and lovastatin. but rosuva or crestor is very expensive. GH gave my mom lovastatin too.

Lifestyle and exercise isn't doing much help for my cholesterol been hovering above normal limits for a few years now.

yeah statins are usually prescribed if the patients has diabetes. hmm not so sure if that's the correct practice though if the consultant does not bother about the lipid profile.

Maybe you should start taking statin then j/k

rosuvastatin has the highest incidence of liver and muscle side effects so it is generally avoided.

Yea, I think I know what are those drugs for after a few years of medical school.

I have not been studying in a while (like really super long) but correct me if I am wrong (I know there are a lot of senior doctors reading, please correct me if I am wrong!)

I have no idea if gemfibrozil actually works in secondary prevention of cardiovascular event - I have not been taught about it, or read about it, or find out about it.

Statins MUST be used in secondary prevention of cardiovascular event as Number Needed to Treat is low (?50, cant remember, depending on which studies you pick and which statin)

Statins, can be used for primary prevention for high risk patient - oh well, nowadays ppl just treat numbers anyway lol even if they are perfectly healthy lol. NNT probably about 1000? pretty low yield.

Perindopril has to be used post AMI as it reduces mortality (er, something to do with cardiac remodelling blabla)

B-blocker, in patient post AMI without significantly impaired systolic function (Ie systolic heart failure), should be commenced on a B-blocker (low dose first, as tolerated) as it reduced recurrent AMIs and ?mortality.

And yea, about the plavix part, I dont know man, I dont know whether the patient had a STEMI/NSTEMI. But the duration of plavix should be documented!!!!!!!!!!!!!!!!!!

ACS refers to both unstable angina and NSTEMI, as both shares similar treatment plan. Plavix is usually continued for 6 weeks post ACS, and up to a year post PCI (dual antiplatelet therapy).

Is that from lecture / real life practice? I see so many cardiologists start people (private prac) on rosuvastatin. Hospital people tend to get atorva.

Not really. Nowadays in hospitals we use more of lova and simva. Reason: cheaper

This post has been edited by hypermax: Dec 17 2012, 09:55 PM

fibrates is more related to risk reduction in diabates compared to a cardiovascular event. its usage is more limited to reduce TGL levels and that's about it

plavix is there to prevent clot formation. working together with aspirin.

from lectures i would guess because its the most expensive.....? anyway, its just more incidence compared to other statins doesn't mean its bad otherwise it would be pulled out of the market.

I'm not too sure where you got your source though, but from journals i read, rosuva has lower incident of rhabdo, and similar adverse event rates compared to other statins. an exception is cerivastatin, which is banned. they do get slight raise of transaminase though.

agreed =P save cost. and hey, they all work well. my teacher called it the miracle drug because it has many other functions too, like stabilizing plaques and etc etc.

So yes I will still give high risk patients statins. and I wont add in a fibrate.... unless the consultant tells me so and consult the pros if you don't know.

Any comments on diuretics and beta-blockers? E.g why they're not given?

its from my lectures made by practitioners. guess in practice its a different story.

both drugs causes hyperglyceamia. which may lead to diabetes if not properly monitored.

U mean in the case of ACS? That's because in ACS the cardiac function is relatively well preserved, unlike in CCF. Thus diuretic is not needed to get rid of the extra fluid.

Beta blocker should be given to patients with ACS, STEMI and CCF, as it reduces the myocardial oxygen demand. However, it should be introduced slowly as patients may complain of worsening of symptoms upon initiation of therapy. Also, beta blocke is contraindicated in COAD or Asthma patients.

Like what zstan said, combination of diuretic and b blocker can cause new onset diabetes melitus. Thus close monitoring is required.

In diabetic patients, statin is still the first line therapy for risk reduction, unless TG>5.7 then fibrate will be used instead.

Btw, the mechanisms for both aspirin and clopidogrel are important for MRCP part 1. One has to know them by heart if keen for MRCP.

This post has been edited by hypermax: Dec 17 2012, 10:52 PM

Exactly why we need more discussions in this thread.

TBH I haven't seen much use of fibrates (none that I can recall, for that matter) so far. Don't know if it has fallen out of favour in Australia (Hobart) or it's just that I've been not looking close enough.

P/S: B-blockers can mask the adrenegic symptoms of hypoglycaemia as well (!use in high risk patients).

Hypermax, are b-blockers and absolute contraindication in COPD and Asthma? I ask this only because I have seen patients on them, where the doctors say, B-blockers work for them.

I guess the benefits outweighs the risk? I think cardioselective BBs will be used to decrease unwanted s/e. but still, it will have more or less affect the airways/FEV1.