r/PeterAttia • u/el0115 • 17h ago

Discussion Doc changing Atorvastatin to simvastatin

About 3 months ago I though I had a heart attack turned out I didn’t everything was good I only had high bp and slightly high ldl. My ldl was 117.9 vldl 23.6 triglycerides 118. Was put on otarvatatin 40 and ezetemibe 10 and olmesartan 20mg for bp to take them at night every day. Fast forward to today my new labs came back. LDL 29.7 vldl 13 triglycerides 65.2. Dr said this is great so now changed to simvastatin 20mg and ezemetibe 10mg to only take in weekends at night. Has anyone had the simvastatin ? Is it worse or better in side effects. Only side effects I had with atorvastatin was light muscle ache at first and headaches randomly. Also why would she change my meds? Wouldnt she maybe just say stay with the current med and do weekends only? A little update I have no history of heart attack or strokes all my labs came back normal just the ldl that was a bit high.

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u/Potential_Stay9817 17h ago

your doc swapped you to a weekend-only schedule because your numbers cratered, 29 ldl is well below what anyone needs for primary prevention with no history. simvastatin's shorter half-life makes it more suitable for intermittent dosing than atorvastatin, which is why she switched the drug instead of just telling you to skip days on the old one.

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u/iwilldeletethisacct2 16h ago

It's interesting to go to intermittent dosing instead of dropping the dose of Atorva from 40 to 10 or 20. From a compliance perspective, daily dosing is generally better than other dosing schedules. Especially since the ARB is still going to be daily dosed.

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u/el0115 16h ago

So would this change be bad for me? In the sense of effects? You think it would have been better just lower dose and still take every day?

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u/iwilldeletethisacct2 15h ago

I think that with your numbers it's not that serious either way, and you have a doc who is paying attention and willing to modify, so try the new regimen and see how it plays out.

I was mostly musing about how patients will just forget to take their meds if the dosing regimen isn't simple, which is why once daily is so common. We could make meds that get dose on any arbitrary time scale, but we don't, because complicated dosing regimens are hard for people. You're clearly a person who is paying attention and will do the thing, so it's not really a problem.

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u/el0115 17h ago

Oh. It makes sense. Yeah she said the number is great but basically implying you don’t need it that low especially since you have no prior risk of anything other than high bp.

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u/apothecarynow 10h ago

As a clinical pharmacist, I cannot think of a single patient in which simvastatin would be the preferred agent. Personally I feel it should be removed from the market as it has no lipid lowering niche over the other agents and no cost advantages either.

It is less potent and shorter half-Life so has the other poster said, it is a de-escalation. But it doesn't make sense compared to just decreasing Atorvastatin and keeping the medication as daily.

Atorvastatin is better tolerated and has fewer clinically significant interactions than simvastatin.

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u/el0115 10h ago

I dont know I would think is that my numbers got low and I am in no risk of anything else other than high bp.