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Atorvastatin 2: Who Should Take It and Why

153 ratings | 12670 views
This video explains how doctors are supposed to choose which people should get atorvastatin. It goes through the doctors' thought process about the numbers behind the decisions. See my other video Atorvastatin 1: General Information and Side Effects https://www.youtube.com/watch?v=oMZ_H_vba00 if you would like a description of the medication.
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Text Comments (54)
Royal Kicks (5 days ago)
is the Atorvastatin Tiginor safe to drink?? am 18 years pls reply if possible
Royal Kicks (5 days ago)
i dont know the numbers..but the doctor had given me that and its 40mg i cut it half which means 20mg..when i drink it the only effect i get so hot after 15mins..its my first day today..am scared am only 86.4kg
CardioGauge (5 days ago)
The tiginor has atorvastatin in it. It is a cholesterol pill. It is usually a safe medication. 1 out of 5 people get muscle aches with the medication. It is unusual for an 18 year old to need atorvastatin. If your doctor is recommending it, your cholesterol is probably very high. Do you know what your cholesterol numbers are? Total cholesterol, HDL, LDL, Triglycerides
Angeelo Gov (6 days ago)
I am not trying to say this drug is 100% amazing but here is my fathers story. My father has been on atorvastatin for at least a decade. He is obese and I believe he would’ve had a heart attack long ago without this medication. However he does have type two diabetes but it is most likely caused by family history and his unhealthy diet. He is on metformin now for the diabetes. The fact of the matter is, this drug is not perfect but without it, the changes of losing my father at a young age would be higher. Also to the people say the pharmaceutical industry is trying to brainwash you. STOP IT. Although the medical care situation is much less superior here in America, countries that have single payer healthcare such as Canada and the UK prescribe Satins to their patients. If the argument that the medical industry in America is trying to make money off you from satins, why are they so inexpensive in America, and why are they prescribed in single payer healthcare countries where making money off of patients is not a priority (unlike America fortunately)?
Faithangel377 (18 days ago)
Statins are dangerous....My husband grew older when he began statins..The longer he was on it the worse he felt....after researching statins I don't believe anything this "Dr" says.....Fear mongering by far ! ....Doctors far more informed than this are warning of the dangers of statins.....I wouldn't risk it. Statistics tell us that Allopathic Doctors are the 3rd leading cause of death...No thanks, I will take my chances and adjust my lifestyle instead.
CardioGauge (17 days ago)
Thanks for your comment. Your viewpoint is important, and very popular now. Allopathic Doctors have a declining reputation, in many cases deserved. I personally am not one to go to the doctor either, and I don't take medications. But your statistic about Allopathic Doctors being the 3rd leading cause of death is misleading. The reason so many deaths are ascribed to medical errors is Allopathic Doctors are the people who take care of people when they are dying. Everyone dies at some point, and most people who die are getting allopathic medical care, because they are trying to not die. So it is always "how come the doctor could not fix the situation?" If everyone stopped seeking allopathic care when they got sick, and instead went to the herbalist, then the herbalists would get all the blame. For example, if a 95 year old patient that I have worked with for years dies because the diuretic medication that was required to keep her out of heart failure was too much for her kidneys, is that a medical error? This type of thing happens all the time. The death is ascribed to a medical "error," when many other interventions along the way, over many years, kept her alive. At the end, there is usually no good option, so the doctor chooses one of these poor options, and there is a bad outcome, and thus an "error." I am all for actual lifestyle adjustment, I guess that didn't come across that well in the video. In my personal experience with thousands of patients, I have about 20 who made the major changes and have a lifestyle that could replace the effect of the statin. I stand firm in my recommendation for people who have had a heart attack or stroke that they should take a statin, if they can tolerate one. For people with strong family history of heart attack at a young age, a statin makes sense, because it can prevent the same thing from happening in the next generation. I don't think it is fear mongering to try to prevent a heart attack in someone who has already had one. If everyone adjusted the lifestyle, the world would indeed be a better place, with fewer big profit medications, and happier, healthier people All the best....
AviPlot (1 month ago)
When comparing a group of people taking statins vs. a control group taking a placebo, the numbers presented show a 25% vs 50% risk of hearth atack/stroke/stent. Now, what about other parameters, like dietary habits, obesity, etc? I assume that most of the data comes from the US, where dietary habits are poor, and obesity and metabolic syndrome are very common. How would the numbers look like if all people involved were eating a healthy diet and/or not obese and/or free from metabolic syndrome? The presentation claims that lifestyle changes (diet, exercise) are beneficial, but there are a bonus that do not replace the need for the drug. Is that so? What if the comparative advantages of the drug become marginal once the lifestyle has been adjusted? Are there any numbers regarding this?
Lalo G (1 month ago)
I’m a middle aged man. I eat well and exercise.I was taking this drug for 10 years, went from 40mg to 10mg. I have not taken since October 2017. I have no immediate family history of heart attacks or strokes under 60, but my father had different cardiovascular issues. I read “blood sugar 101” by Jenny Ruhl and it says an A1c test is a good predictor of hearth disease. Anyway, I’ve lowered my A1c to 5.6 and currently have a total cholesterol of 217, an LDL 146, HDL 61 and triglycerides 49. However, I will request an advanced lipid panel test to check Apo B, SdLDL, and check for inflammation on my next doctors visit (sometimes patients need to become mini doctors to help themselves). Do you think I should continue on Lipitor regardless if I have pattern B LDL?
Lalo G (1 month ago)
CardioGauge good info. Thanks doc.
CardioGauge (1 month ago)
Hi thanks for your question. Sorry I can't give you direct advice, because I'm not your doctor. Everything that follows is health education, not medical advice... Because you don't have a diagnosis of cardiovascular disease, and you don't have a family history of vascular disease, I consider the Lipitor "optional" for you. I occasionally have a patient who is interested in going beyond the usual risk predictors to decide if Lipitor makes sense. The main tools I use to decide if someone is at higher risk than they appear with basic risk measurement are 1) Coronary Calcium Score, and 2) hs-CRP testing (high sensitivity C reactive protein). For me, the coronary calcium score is the most useful, because a score of zero is very reassuring while a high score like 300 or more indicates a 6 fold increase in risk compared to somebody with a score of zero. When my patients have a score of zero, I generally do not treat with lipitor, whereas if they have a score of 100 or more, I will recommend treatment. With regard to hs-CRP, which I believe is the test for inflammation you will be getting, a high hs-CRP indicates an approximately 2 fold higher risk than someone with a normal hs-CRP. So the Calcium score is a more powerful predictor of risk than hs-CRP. Having pattern B approximately doubles the risk as compared to not having pattern B, so it has similar predictive power to hs-CRP. If my patient was in your shoes and had pattern B, I would recommend the Lipitor and healthy lifestyle. But if the person did not have pattern B, I would probably recommend just pursuing a healthy lifestyle. Bottom line is, I prefer people to really focus on diet and exercise instead of medication if they are at low to intermediate risk. For many people at high risk (more than 20% risk over 10 years), I am a believer in using the medication in addition to diet and exercise. My website has the basic risk calculator on it, you may have already done all that on a different site. If not, please check it out, cardiogauge.com, and click health summary
Providence Kaminski (1 month ago)
when should i take Atorvastatin morning or night ??
CardioGauge (1 month ago)
You can take whenever convenient for you. A small study showed it doesn’t make a difference when you take atorvastatin. The statins that should be taken at night are simvastatin, lovastatin, and fluvastatin.
Divyeshwar Pradhan (2 months ago)
Respected Doc, I had an MI
CardioGauge (1 month ago)
Hello, I can't tell you what to do, but I can tell you what I do with my patients in this same situation. When my patients who have had numerous stents get severe muscle aches, I always wonder if it is the statin causing the muscle aches. I will stop the statin for a month like you mention, and see what happens. If the muscle aches go away, then I will try the statin again at a lower dose. For example if my patient was on atorvastatin 40 mg, I will restart it at 20 mg dose and see what happens. If significant muscle aches occur again, then I will try rosuvastatin 10 mg per day, because some people tolerate rosuvastatin better than atorvastatin. I have a rare patient who has success with coenzyme Q 10 supplement giving relief of muscle aches at 250 mg per day. Best wishes!
Divyeshwar Pradhan (2 months ago)
Respected Doc, I had an M I 20 years back and upto now4 Angioplasty procedures with stents underwent. Taking 40 m.g. Of Atorvastatin regularly, but now I have developed muscle ache unbearable. My cardiologist is hesitant to change the group of statin. Will it be desirable to stop Atorvatatin for say a month and re-start once the muscle pain subsides a little bit ? D. Pradhan
Shawnta Chapman (2 months ago)
Why it change your color urine ?
CardioGauge (2 months ago)
Atorvastatin can make urine brown by killing muscle cells. That is called rhabdomyolysis, and if this is happening, medicine has to be stopped. If urine is turning brownish or is much darker than usual, you must tell your doc.
William McKenzie (2 months ago)
Please comment on the appropriate dosage for Atorvastatin.  You mention 80mg in this video.  My Doctor has me on 20mg.  Is there a linear relation?  Is 80 mg 4 times more effective in reducing risk than 20 mg?
William McKenzie (2 months ago)
Thank you!
CardioGauge (2 months ago)
The cholesterol guidelines (written by expert physicians in various specialties) tell docs to give people age less than 75 yrs old who have had a cardiovascular event (stroke, heart attack, or stent, or blockage in other artery) atorvastatin 40 mg or 80 mg per day. This is considered high dose atorvastatin. For people who have had an event who are older than 75, the guidelines recommend at least atorvastatin 20 mg per day. For people who have never had a cardiovascular event, guidelines recommend doses from 20 up to 80 mg per day, depending on the calculated risk. The doctor uses the "Pooled Risk Calculator" to come up with a given person's risk percentage. However, overall, the atorvastatin 80 mg and 40 mg doses are emphasized for people less than 75. For people 75 and older, the guidelines state it's optional to treat with atorvastatin The guidelines state that atorvastatin 20 mg per day decreases chance of stroke, heart attack, stent by about 30%, whereas 40 - 80 mg dose decreases the chance by 45% ( I round it in the video to 50% to simplify calculations). So that is all according to the text book. But no one has ever tested 80 mg of atorvastatin vs 20 mg of atorvastatin, so the 80 mg dose is not absolutely proven to be better than 20 mg dose. Based on the studies, I agree with the estimate that a 20 mg dose, on average, gives a person about 2/3 the benefit that the 80 mg dose would give. I am quite sure that it is not a linear relationship between dose and reduction in risk, both based on experience and the trials of the medication. Other factors: some people tolerate 20 mg no problem, but are intolerant of 80 mg. For them, 20 mg dose is better. Some people will have LDL less than 40 (very low LDL) on 80 mg dose, so the dose is reduced to allow the LDL to be more than 40. Overall, I consider 20 mg to be a good solid dose of the medicine, and that it gives a good reduction in risk, compared to the high dose. So, for example, for someone with a calculated risk of 20% over 10 years, if he/she took atorva 20 mg for the 10 years, risk would go down to about 14% for the 10 years. Eating right and exercising routinely would bring it down further. Apologies for the long winded answer, I hope that it addresses your question adequately.
Siok Oey (2 months ago)
I think just drink small pill like 5 -10 mg only
Bibi Shakira Jameel (2 months ago)
Thanks for responding so kindly..at least you are honest..Best wishes to you...
Bibi Shakira Jameel (2 months ago)
Respect to you Doc but I don't believe in those drugs...I think you are trying to push it here...as expected...your job though...my mom never got better with meds by incompetent or careless doctors...
CardioGauge (2 months ago)
Bibi Shakira Jameel thanks for your comment. I believe statins help some people, but unfortunately they do not help most people. Statins are not “The Answer” they are made out to be. So many cases where people were not helped like your mom. I find atorvastatin to be a useful but frankly mediocre medication in the fight against heart disease. Best wishes...
The Pale Horse (2 months ago)
He talks horse s^^^ from his mouth! Look in his eyes and you see that he is lying!!!
Leif D (2 months ago)
Dr. I am on a vegan whole foods plant based diet. Ive had cholesterol readings in the 225 range and 125 ldl range in the past. My latest readings were 127 overall cholesterol, 56 ldl, 54 hdl and 83 triglycerides. My lipitor dose is 10mg daily which my Dr agreed to lower to 10 mg every other day. My question is should i be on lipitor at all ? 127 seems awfully low, should i be medicated at this point? (Ive never had a cardiac event).
Leif D (2 months ago)
CardioGauge Thank you for your response. At my next appt,if all is still well, I will discontinue the statin. This will be very satisfying because previously I'd been told that I was on these drugs for life. I hope that the WFPB diet will do for others what it has done for me, Drs should actually prescribe it! Thank you again.
CardioGauge (2 months ago)
Hi Leif, for my patients who have never had a cardiac event, and do not have a strong family history for vascular disease (mother, father, sister or brother with heart attack or stroke at young age, ie less than 60 yrs old) and have cholesterol numbers like you do now on your current diet, I would not use statin. The proof that the medicine will help someone in your situation is weak. The chance that it would help you is low. Stopping the atorvastatin 10 mg per day would probably put your LDL at around 75 - 80, which is excellent. Your numbers are not dangerously low now. Many people who eat a very healthy diet will walk around with numbers like you have, without apparent consequence. In studies of cholesterol medicines, there was no ill effect of LDLs in the 40 - 60 range. How low is too low? No one knows! I consider LDL less than 30 to be too low, but that is arbitrary on my part. Your doc may be using the "textbook" to decide whether or not to treat you, which I consider to be ok. Doc is supposed to calculate your risk for cardiac events over the next 10 years (you could google "pooled risk calculator" to calculate yours). You use the cholesterol numbers off of treatment to make the calculation. If the risk is more than 7.5%, doc is supposed to give you statin. Several parameters are used to decide your risk level: age, gender, blood pressure, presence or absence of diabetes, and cholesterol numbers. I hope this is helpful! Please feel free to ask follow up questions...
Kathy Hudgins (2 months ago)
My hubby just had two stents put in back in Sept. and they put him on the Lipitor generic and that has went against him bad in his legs, he has actually had them give away on him to almost falling. They changed him to Pravastatin and he has been on it for two days now. The thing is, he has a very good cholesterol level and always has. He is NOT wanting to take them and I don't know what to do! He is determined not to take this! He is buying into what Dr. Lustig is teaching. His doctor told him that all his other arteries look very good at his age (78) was just the one he had issue with that the two stents were put in. ((((Question: If the strict diets for the ones without the stents etc. do so great, then why not with those who do have the stents?))))
CardioGauge (2 months ago)
Disclaimer: The following information is health education, not medical advice. Only the individuals personal physician can make recommendations regarding diet and medications. Hi Kathy. What you describe is a common situation. A lot of my patients have had trouble with atorvastatin like your husband. I will see the patient in the hospital who has been well, with normal cholesterol levels, but they are having chest pain from coronary blockage. They get stent, and then go on atorvastatin. We give this to basically everyone who has coronary blockage, with or without stent. Then, the person does not tolerate the medication. My experience is about 1 in 5 people do not tolerate it, usually the symptoms are muscle aches or muscle weakness, as your husband has. My standard next step is to give them a different cholesterol medication, as your husband's doctors have done with him. I consider pravastatin a good choice. Here is a link to the scientific study that supports the use of pravastatin in this case. http://www.nejm.org/doi/full/10.1056/NEJM199811053391902 Over 6 years of taking the Pravastatin 40 mg per day, Pravastatin decreased the chance of death from 14% down to 11%. This applied regardless of the starting cholesterol level. So the fact that your husband has a normal cholesterol level to start with does not mean that he does not need the medication. This is frequently a confusing fact to patients, with the docs recommending cholesterol medication when the cholesterol numbers are normal. I point out to my patients that blockage (which is generally made of cholesterol) developed with normal cholesterol levels to start with, so it still makes sense to treat cholesterol. I find that about half my patients who do not tolerate atorvastatin do not tolerate any of the statins. Pravastatin is probably the best tolerated of all the statins. The reason we do not choose it first is that it is not as strong as atorvastatin, and it does not prevent as many strokes and heart attacks as atorvastatin. If your husband does not tolerate pravastatin, his doctor may try yet another statin. It probably would not work out, however, it is worth a try, because the medication decreases the chance of death, stroke and heart attack. I personally stop trying after 3 treatment failures. So the reality is, many patients who have stents are unable to take statins. There are several other oral medications which can be used to decrease cholesterol, but they are not very effective. Examples are ezetimibe, cholestyramine, colesevalam, niacin. I personally rarely use these medications for patients. I use them when a patient's cholesterol numbers are very high. I don't observe them to be effective like the statins are, in reducing heart attacks and strokes. The science also shows they are not very effective. There are new injectable cholesterol medications which your husband's doctor may consider. Evolocumab (Repatha) was shown to decrease heart attack/stroke/death from heart disease recently. Where I practice, we are generally unable to obtain it if the LDL cholesterol is less than 100. Co-pay can be as much as $400 per month, although this varies. I only have 4 patients on this medicine. The total cost of the medication is astronomical, something like $1000 a month. In addition, it is new, so the exact side effect profile and risks associated with its use are not fully described. I only use it in people who can't take statins who develop blockage at a young age (less than 60 years), or they have very severe disease (blocked arteries in neck, legs, or have had bypass surgery). Your husband's other medications are important, especially aspirin and the other antiplatelet medication given to him after the stenting (usually Brilinta or clopidogrel). While the doctors would like him to be able to take all of the recommended medications, if he can't take the statin, he should still take the other medicines, because these are a big help, independent of whether or not a person is on a statin. Regarding diet, I have not read any of Dr. Lustig's work, but I am familiar with some of his ideas. I agree, as do most people who work in healthcare, that sugar is an unnecessary food item, and basically not good for us. My favorite book for patients with heart disease is Caldwell Esselstyn's "Prevent and Reverse Heart Disease." He lays out the evidence for switching to a vegan diet, to improve heart health and possibly reverse coronary blockage. I do not know for a fact that switching to a vegan diet will reverse blockage, but it is possible. Good research is lacking. However, a vegan diet is not the answer for everyone. Many people simply cannot tolerate it. They feel terrible or depressed on it. Here is a link to an article about this, if you are interested. http://www.bbc.com/news/uk-41158365 In my patients who are unable to do a vegan diet, I recommend the Mediterranean diet. There are many books. Here is a link to a study about the diet. http://www.nejm.org/doi/full/10.1056/NEJMoa1200303 Interestingly, in the study, the benefit of the diet is approximately equal to the benefit of being on a statin. Although there has never been a test of Diet (Vegan or Mediterranean or otherwise) vs. Statin, my guess is they'd have similar decrease in heart attack / stroke / death. Probably, combining the two (vegan diet + statin)would give the best results. But there has been no direct scientific study of this idea, to my knowledge [youtubers please direct me to any study if you know of one]. That all was a long winded way of saying that your husband's diet is very important, and by making changes, he can decrease his chance of stroke / heart attack / further stenting. Choosing a great diet would have the same effect in someone who had a stent, as compared to someone who has not had a stent! Best wishes. If you have any other questions feel free to submit.
sabyasachi sen (4 months ago)
U ARE DELETING COMMENTS THAT CRITICIZE U. LOVELY
Tanya Pelep (4 months ago)
i have a question. can the right amount of water intake help in lowering bad cholesterol? along with taking statins
irma dennington (6 months ago)
Rubbish, statin is so dangerous!
CardioGauge (6 months ago)
Thank you for comment. It is important for people to know that Statins can be bad for some people. But they can be life saving for others! If a person has a heart attack or stroke, the medicine can decrease chance of having another one by 1/2! I don't want to discount your comment, Statins are poison for you, but that does not mean they are bad for everyone. Best wishes...
irma dennington (6 months ago)
No! I suffered too much from the side effects! Kidneys and liver damage! I stopped taking and now recovering and no more aches and pains!
Retchel Arabis (7 months ago)
Gud evening doc.my cholesterol is 253.39, im 40 years old female.can i take a atorvastatin medicine tnx
CardioGauge (7 months ago)
Yes. I have given atorvastatin to women your age. You just have to make sure you don't get pregnant when you are taking it, because it is not known for sure to be safe for the baby. If you were to decide to become pregnant, your doctor would likely advise you to come off it first. Disclaimer: This is not medical advice but rather health education. Only your doctor can tell you what to do with your medications.
DurantFan (7 months ago)
This makes me want to eat better. 😨 I don't want to be on medication for something I can avoid earlier in life.
CardioGauge (7 months ago)
I agree!!
Judy Delgado (7 months ago)
I have taking atorvastatin 20 mg a day for 9 months but I just discovery that I am pregnant and I think I have 8 weeks of pregnancy. How dangerous is this medicine for a baby? Send me response to jvero_dv78@hotmail.com
CardioGauge (7 months ago)
Hi Judy, I sent a response to your email. The following article is about the subject you bring up. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2048566/ Best wishes.
mum (8 months ago)
Docs sure love their statistics.
CardioGauge (8 months ago)
thanks for the link, I enjoyed the podcast. Dr Mukherjee is a wonderful communicator, and entirely fact based. He is the type of doc I look up to!
mum (8 months ago)
thanks Doc....I would never wanna be you...but I respect what you feel the need to uphold....science is real...stats are true...absolutely! But your admission here of "docs would get sued if they didn't prescribe this drug" says it all.....i have lived through cancer and high blood pressure and a thousand opinions and statistics....sometimes you just wanna have a sandwich..........https://www.samharris.org/podcast/item/into-the-dark-land
CardioGauge (8 months ago)
That's horrible, I'm sorry to hear that
mum (8 months ago)
jeez...thanks for the defensive and all too obvious reply.......miss the point much? Irony deficient perhaps? Methinks so...you might wanna get that checked out. My wife died of stage 1A clear cell ovarian cancer. Lay your stats on me for that one Mr> Bad Analogy Man. I know them all. Pfft.
CardioGauge (8 months ago)
Yes, math is an important subject. That's how planes, cars, and computers are made. That's how medicine works, not by magic, but by science and math. Thanks for pointing that out!
Klee N (8 months ago)
dr 80 mg has a warning does it not that that dose can caus bad complications? I believe the FDA warned of this in 2011
CardioGauge (8 months ago)
You are right, the highest dose has higher chance of complications than lower doses. But also, the 80 mg dose has higher chance of preventing stroke and heart attack. So for most people we tolerate the higher risk of side effect because of the stronger effect of decreasing heart attack. This is especially true for people who have already had stroke or heart attack. If any of my patients feels poorly on the high dose, I give less, or try rosuvastatin. Regarding the FDA warning, I think you are referring to the Simvastatin 80 mg warning. We no longer use simvastatin 80 mg. Right now, doc's textbooks and guidelines list the desired dosage of atorvastatin as 40 or 80 mg in most cases.
Klee N (8 months ago)
my husband has nueropathy so bad he cant feel the bottom of his feet
CardioGauge (8 months ago)
neuropathy usually not caused by statin, i believe it happens in less than 1%. But there are definitely reports of it happening. If there is no other apparent cause of neuropathy, I stop the statin. I have only done that a couple times in my career.
VAMPIRE IRON (8 months ago)
I'm on 100mg metoprolol twice a day. Amlodipine 5mg per day. 25mg hydrochlorothiazide. And 10 mg atorvastatin daily. Age 43 male. Was 180/120 relaxed and 250-300/128 in the gym doing mild exercise. Now I'm 127/70-80 relaxed 3 months later.
Val O'Brien (8 months ago)
STATINS destroy the brain, the brain needs a certain amount of cholesterol this is a known fact. I know about five people on STATINS who have lost their mental agility and walk around in a zombified state. You can get the same results as a Statin by changing the diet. I had a Cardiac Arrest on Christmas Eve and was put on Avortostatin also had a stent put in my arm, I only take the Statin now and then I feel that pharmaceutical companies are brainwashing people about these drugs, and use fear to promote their products.
CardioGauge (8 months ago)
Thanks for your comment. Most people don't have measurable brain problems with atorvastatin. It was studied, if you believe the work of medical scientists: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458855/ The most common heart medication causing someone to feel like a zombie is metoprolol. Similar medicines cause the fatigue / tired / unfocused feeling in up to 20%. I have only had a couple of patients over the years who seemed to have mental side effects from atorvastatin. Seriously, maybe your friends are on beta blockers and that is what is zombifying them. The drug companies don't make much off atorvastatin any more because it is generic. It's cheap. you will notice there are no ads for it any more. The statins are washed up in terms of profits. The drug companies have moved on to the injectable cholesterol medications Repatha and Praluent, which are indeed a complete rip off at $1,000 a month!!! I'm glad you are on atorvastatin, because it is an important medication for you, having had cardiac arrest and stent. And statins don't drop your cholesterol beyond what it is "supposed" to be. Societies that have no coronary artery disease (Rural China for example) have average LDL cholesterol of 50. That is around what most Americans' LDL would be on 80 mg of atorvastatin. So there should be enough cholesterol around to make your brain and everything else work ok. There are exceptions, where people do badly with atorvastatin, but most people (80%) do fine with it. My favorite book for people living with heart and blood vessel disease is Dr Esselstyn's "Prevent and Reverse Heart Disease." Best wishes!

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