I am a 65 year old woman, smoker and hypertensive. I have been on telmisartan, nebivolol and rosuvastatin/ezetimibe therapy for a year for high cholesterol and so-called “atherogenic” dyslipidemia. Total cholesterol is 136, HDL 62, LDL (on statin therapy) 64.2. The plaques have quite increased, despite the fact that I have quit smoking for about six months. Unfortunately rosuvastatin/ezetimibe gives me muscle aches, which didn’t happen with a monacolin-based supplement from red yeast rice, phytosterols, fenugreek and linseed oil. Ggt (gamma glutamyl transferase, a liver enzyme, ed) has also increased. Should I change my therapy? Could aspirin help keep plaques under control?
He answers Paolo WerbaHead of the Atherosclerosis Prevention Unit, Monzino Cardiology Center, Milan (GO TO THE FORUM)
There are several aspects to your question. Primarily the increase in plaques, which I assume are carotid. The evaluation of the volume of a carotid plaque with ultrasound-based methods it is not simple and it is possible that, in subsequent studies (especially if they were performed by different operators or with different instrumentation), the results may differ, more due to method differences than due to a real change in the size of the plate. Furthermore, the minimum time necessary to perceive a significant change (improvement or worsening) is, in general, quite long (years and not months). On the other hand, he did very well a stop smokingbut the effects of cessation at the plaque level may not be felt in just six months.
Regard muscle aches with rosuvastatin/ezetimibe, this happens in about one in ten patients taking these drugs, and there are strategies your doctor can take to deal with the problem (reduce dose, alternate day therapy, change statin), depending on your personal history (use of other compatible drugs, previous experience with other statins). They also exist innovative drugs to reduce cholesterol which, in some patients with statin intolerance, may be prescribed. The aspirin should be used, in primary prevention (people who have not had a stroke, angina pectoris, heart attack or other clinical manifestations of atherosclerosis), only when the plaques exceed a certain severity and there are no conditions that increase the risk of bleeding complications, mainly gastrointestinal or cerebral. In conclusion, only your doctor will be able to evaluate the cost/benefit ratio of a treatment with aspirin.