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Have diabetes, BP, cholesterol and anxiety. Done blood test. Can I reduce Atorvastatin because SGPT is high?

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I am obase (Wt:120Kg, Ht:5-11) and have Diabetes, B.P., cholesterol, anxiety/Schizophrenia.
Today I received my Blood report.
HbA1c: 7.0
SGPT: 67.80
Choleterol total: 127
HDL: 32
LDL: 76
Triglyserides: 97
Createnine serum: 0.85
Vitamin B-12: 225.00
Vitamin D total: 9.31
ESR: 25
Thyroid: Normal

I want your guidence:
1) As SGPT is high and Cholesterol is on lower normal, Can I reduce my Atorvastatin dose of 10mg daily to 5mg daily?

2) Considering my weight, my B.P. (sitting) remains around 130/90. (I am on Amlodipine 5mg once and Losartam Potassium 50mg twice a day.)
a) Is Losartan not acting?
b) I add Hydrothiazide XXXXXXX 12.5 mg once daily
c) It's fine

3) Any suggestion of medicine for low Vitamin D? I am on becadexamine (Glaxo) once a day.

4) What could be cause of high ESR? Any suggestions?
Posted Mon, 21 May 2012 in Hypertension and Heart Disease
Answered by Dr. Prasad 5 hours later


Thanks for posting your query here.

I appreciate your concern to seek guidance on your health problems. I shall try to address your queries in the best way possible.

I went through the results of the tests. As the reference values may differ for a few tests at different laboratories, it would have been useful if you had also mentioned the reference limits along with the results.

Nevertheless as few tests have standard reference limits, I shall answer as many queries as possible.

1. Your Serum Glutamate Pyruvate transaminase (SGPT) levels are not alarmingly high and cholesterols are not concerningly low. However as the levels are slightly affected, we can consider reducing the dose of atorvastatin. Discuss with your prescribing doctor about it.

2. Blood pressures of 130/90mmHg in a 52 year gentleman is in ideal limit. I would not wish to decrease the pressures further. Further lowering blood pressure may not be right on the heart and brain. Hence your current blood pressure medications are fine. You need to continue as it is.

3. Reference values of Vitamin D can vary among laboratories. If the values are low, you can consider taking Vitamin D supplement such as cholecalciferol granules and increase sun exposure. It might also help to increase dietary consumption of calcium like milk and non vegetarian diet.

4. Erythrocyte Sedimentation Rate (ESR) is a non specific marker of inflammation. It becomes higher due to myriad of conditions. In the absence of clinical symptoms, I wouldn't be concerned if the levels are below 100.

Lastly, after having read through your reports, the glycosylated Hemoglobin (Hba1c) values are not in the ideal range. You may need to review with your prescribing doctor to look at your diabetes management. Weight reduction is highly recommended.

Hope this answers all your queries. Let me know if I have missed out on any other concerns.

Wish you good health

Above answer was peer-reviewed by
Follow-up: Have diabetes, BP, cholesterol and anxiety. Done blood test. Can I reduce Atorvastatin because SGPT is high? 2 hours later
Dear Sir Dr. XXXXXXX

I have attached my complete blood report taken yesterday with this query (MRJAWAHARDALAL.pdf). In this report, all the upper and lower limits (reference limits) are present. Please review it for my sake. Then, revisit your anwser considering my weight as 120Kg and Height as 5 feet 11 inches and 52 years as my age. Also, all my current medications are given.

With all these information, please revisit your anwser.

I do not want to visit my physician for the change in prescription, that's why I have posted my queries here.

1) Shall I reduce the dose of Atorvastatin from 10 mg to 5 mg in light of SGPT and my Lipid profile results?

2) For B.P., you are happy with 130/90 (sitting) considering my age. (consider my weight and height also).

3) For, vitamin D, please suggest a suitable pill to be taken in addition to Becadexamine; as it can also affect positively in my diabetes management.

4) Any idea/guess why my ESR may be high as 25 in view of my entire blood report and my medications? Reference limit is in the report. (I do not have Rheumatoid Arthritis.)

Thanks a lot in anticipation of revisiting your anwser again (in light of my blood report in pdf file, and my current medications) and answering my above mentioned questions in follow-up.

Thanks & Regards,
Answered by Dr. Prasad 13 hours later

Thanks for uploading the reports. I have gone through it.

1. Atorvastatin rarely produces liver injuries. Moreover drug induced liver damage is characterised by elevated liver enzymes (both SGPT/SGOT) and bilirubin levels. In your case, the mild and clinically insignificant rise in SGPT may not be due to Atorvastatin.

We can plan its withdrawal if your cholesterol continues to be lower. Weight reduction and proper diet might help you achieve this target.

2. Yes, your blood pressures are well within limits. Let us keep this up with your current medication. I do not find you reasons to change your blood pressure medications for now.

3. Vitamin D levels are mildly lower. This perhaps could be due to nutritional deficiency. A diet XXXXXXX in vitamin D along with cholecalciferol granules (available over the counter) - once a day for 2-3 months will improve the levels.

4. As mentioned in my previous reply. ESR is a non specific marker of inflammation. It is found risen in multiple causes. You seem to have low hemoglobin levels (Hb of 12) which itself may cause slightly elevated ESR. There could be other factors too. However as the levels are not significant, the contributing factor are more likely to be a sinister problem and do not warrant medical attention.

The bottom line is all your reports are fairly normal and does not indicate a serious problem. All your current medications are fine. We could perhaps reduce and stop atorvastatin. This could be achieved by proper nutrition, exercises and weight reduction.

Hope I have provided you a comprehensive analysis of your blood test and its management.
Please accept the answer and close this discussion if all your queries are answered. Yet, if you have any other queries, feel free to post them. I will be glad to assist you further.

Wish you good health.

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