Hello Doc,

Statins have a specific mode of action of inhibiting HMG co A reductase enzyme. This enzyme is known to halt the process of cholesterol biosynthesis in the liver. Thus in simple words, it shuts down the manufacturing factory of Cholesterol. As a result, LDL which transports the Cholesterol molecules from Liver to the target organ also reduces down as there is no cholesterol to be transported.

Inspite of this, many patients do present with elevated LDL and Cholesterol levels because Cholesterol is not only manufactured in the Liver, but it is manufactured in almost all cells of the body, brain and intestine also.

Statins are normally branded by certain pharma companies to halt the progress of Atherosclerosis, but that is not completely true. They change the plaque composition to a certain extent instead of reducing down the plaque size considerably. As per Asteroid trial, Statins could reduce the atheroma by 6.8 cu mm only even after intensive statin therapy for 24 months.

Visit this research paper to know more about it.

Asteroid Trial

https://www.ahajournals.org/doi/full/10.1161/hc2901.093188

Secondly, Statins are marketed to reduce down the mortality rate by reducing down the incidence of heart attack. If possible, click the following link to understand things better.

The above trial says that if 217 patients consume Statins for 5 years, only 1 patient can avoid a Heart attack.

In such a scenario, one should not fear to taper Statins for your patients. Having said this, we need to follow a specific guideline to taper Statins.

Taper statins as per the protocol in a compliant patient under your regular monitoring if,

1. Total Cholesterol is below 200 mg/dl
2. LDL is below 100 mg/dl
3. TG is below 100 mg/ dl

Along with tapering, every clinician has to regularly monitor for lipid profile, Vit D3 and relevant vitals at specific frequency. Guide the patient for the diet restrictions and regular exercises with cessation of smoking and control on alcohol intake.

Few patients who are non compliant to above guidelines, its advisable to refrain from tapering Statins and antioxidant medicines or supplements.

For more details about tapering medications talk to your ZMH for specific protocols.

Yes Doc!

We can use Framingham risk score for initial screening. No doubt.

It is calculated on the basis of whether the patient is Diabetic, HTN, Smoker and his Lipid levels. As an initial screening, we can use this as a home based questionnaire. Infact, the branding and lead generation team in our organization screens the patients on the same criteria before sending the patients to the clinic. Limitations of the score lies in it being a very preliminary screening process, nothing else.

When it comes to screening inside the clinic by a doctor, further investigations like ECG, Stress test and ECHO can be better tools to diagnose the patient better.

Hello Doc,

As per our treatment protocols, we have not finalized with guidelines for Renal failure.

Hence such a patient can be treated for DM and HTN only. While treating so, clear instructions need to be given to the patient to meet her Nephrologist.

As of now, Madhavbaug doesn’t have clear defined treatment guidelines for reversing Renal failure.