Hi there,

Thanks for writing to me.
I read your mail and attachments with diligence.
Apart from thyroid for which you are taking the right drug, you have following problem with lipid profile:
Increased bad cholesterol component - Triglycerides normal 150 mg% it is >200
Decreased Good Cholesterol component that is HDL below 40 mg% it is around 34
Both are independent risk factors for coronary artery disease.

The drugs you had been taking are only two, at times one of the two at times combination only trade name had been different. You had been taking ATORVASTATIN either alone 10 mg or in combination with FENOFIBRATE 145 mg. Trade names do not matter.

In my opinion best result for HDL and Triglycerides are with combination therapy of ROSUVASTATIN 10 mg with FENOFIBRATE 145 mg, it does not matter which company's salt you use, for HDL rise is not adequate without getting into some exercise program. AIM for daily exercise should be brisk walk for 40 minutes (by brisk I mean 5 KM/Hour speed, it can be slow in the beginning and later on increase to 5. If it is raining walk briskly in covered pavements or in the shopping malls. Secondly, the minor side effects of atorvastatin fenofibrate and rosuvastatin are similar. They are mainly gastrointestinal constipation gas. If you get severe muscle pain or liver disease please report to the doctor. You can choose either of these preparations: ROSUFIT F, ROSEDAY F, ROSULIP F, CREVAST F, ROZUCOR F (Each containing 10mg Rosuvastatin and 145-160 mg Fenofibrate). Take one tablet at dinner time. Monitor liver function tests and lipid profile after one month. If there is any more question or clarification, I can give please mail me I will be able to answer. Good Luck.
With Best Wishes
Dr Anil Grover,
Medical Specialist & Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

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Dear Mr XXXXXXX

I have reviewed a single report from Sanjivini Hospital and Excel Chart from my personal email. I assume the same excel chart has been sent. Salient feature of your report are.... some of the variations are definitely caused by various medications you were taking, your diet with respect to oil/ghee/fat and sugar and your physical activity. But in general it would be fair to draw following inference:
1. Your Total Cholesterol with help of remedial measures and drugs has been within normal limits.
2. Among the various components your LDL has been well controlled.
3. More or less even when your cholesterol and LDL is within normal limits barring a couple of readings, we can surmise that: a). Bad Component Triglycerides are elevated from Nov 2009 onwards except five times on May 2010, July 2010, May, 2011, July 2011 and January 2012. That means with diet/drugs and exercise it can be controlled.
4. Good Cholesterol if we take 45 in healthy man is the lower limit from 2008 except for two times February 11 and July 11 the value has been borderline low to very low.

Fortunately, all three drugs Rosuvastatin, Atorvastatin and Fenofibrate are effective against triglycerides if you combine them with healthy life style that is exercise at least 40 minutes brisk walk at the speed of 5 KM/Hr daily and diet low in cholestrol, that means red meat and egg yolk is out. Roasted chicken, Roasted Fish is in for non vegetarian. Skimmed milk and XXXXXXX leafy vegetables are in for vegetarian. Cooking medium any which is liquid at room temperature is in (except coconut oil). Better are fish oil, soyabean oil, olive oil but advantages is marginal. A Chart of your favorite foods, for their cholesterol value, can be prepared if you name them.

Coming to drugs which are effective against low HDL to raise it. All anticholestrol drugs have some value. But those who can tolerate (my patients have little complaints when it comes to NIACIN NF 500 mg) as flushing is major side effects. NF in niacin stand for No Flushing. I prefer to give combination therapy, so I had suggested Rosuvastatin 10 mg (maximum tolerable dose 80 mg) Fenofibrate (optimal dose 145 mg but micronised form 67.5 is also available) and Niacin NF 500 mg (maximum dose suggested 1000mg) will be a good combination for you. Some gastrointestinal side effects are expected these are mild and tolerable. Serious side effects for which drug has to be withdrawn are effects on muscle and liver. Fortunately, these manifest early so the muscle enzymes and liver function tests are checked initially (if no complaints) after one month and thereafter yearly. Drugs combined with diet and exercise literally remove this risk factor from picture. Yes, if Niacin is also taken flushing is disconcerting side effects, which I have not seen with Niacin NF.

If there are any specific or general questions I will be only too happy to answer.

With Best Wishes
Dr Anil Grover,
Medical Specialist & Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

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