Your DD is amazing
I would just caution that Crestor is the strongest Statin .....Pitavastatin is more for those that experience muscle cramping with the stronger Statins .
The ideal combo IMHO is Crestor / Vascepa and Zetia ( if the Improve it trial shows CV benefit for Zetia)
Crestor is not a large pill , Zetia is a very small pill ...a combo may be possible with Vascepa
Should mention one thing about combo drugs tho ...patients like them ( easier to order etc. ) but some MD's don't , because if there is an adverse event which drug in the combo is the cause ?
My lipid panel at Kaiser including the blood draw costs me $45
If you have any family history of heart disease or diabetes , I suggest you get one ( ask them to measure your blood sugar levels as well )
One final comment ..re Pharmacists ...when I picked up my Vascepa it cost me $132 as my insurance would not cover . I asked the pharmacist why couldn't I use DS alternatives ...Her answer " Because at 4 gms strength we want to be sure you are getting the best quality and the exact quantity "
A cautionary note to AMRN longs tho ...For AMRN to hopefully become a rewarding investment , Vascepa must be affordable ( as well as proving CV clinical benefit )
. Not many will be willing to pay $7 a daily 4 gm dose with no co pays or coupons
So low insurance co pays are essential
I see my reply did not post so I'll try a shorter version.
Numerous studies show that lowering high TG's in AT RISK patients reduces CV events ..particularly those with low HDL and high TG combination ...chk the EPAdruginitative site
Vascepa is an FDA approved drug and regulated as a drug . OmegiaVia and PlusEPA are supplements and are regulated as foods ..quality and quantity of EPA vary. However ..OmegiaVia EPA provides a lower cost / lower quality alternative for those that can not afford Vascepa with the Amarin coupon or get affordable insurance co pay .
Vascepa with a $50 a month copay or less is the best option
My blood tests are $45 every 6 mths . Consult with my Cardiologist is by email
Agree with your post . Adding Kowa sales people is a net positive , they have a background already in Cardio Vascular treatments
Just a few comments.
In my experience MD's do not prescribe dietary supplements
Regarding Epadel , Vascepa , EPA etc ... If you read the patent info for Epadel ..it is NOT DEVOID of DHA ...a small pt but the reason why Amarin was able to patent AMR101 ( now known as Vascepa )...since AMR101 was DEVOID of DHA
I think my views on Vascepa vs OmegiaVia vs Plusepa are fairly clear ..see post to Shockbite
Lick ..quick follow up ..actually been on this ( health issues ) since 1985 ...part of a CV trial at UCSF .. ..
Vascepa appears to be synergistic with Stains , also lowers inflammation ( which Lovaza does not do ) and improves the EPA /AA blood serum ratio .
My own view is that TG's are just the marker they are using ...real benefit is likely to be because of how Vascepa improves the EPA/AA ratio.
Well Lick a few comments before I head out for a morning hike
The quick answer to why I don't use Lovaza ...because it can raise LDL cholesterol
The long answer ..and I don't mind responding to bashers ...is as follows
My main lipid disorder is familia hetero hypercholestremia ...about 1 in 450 in the US , 1 in 250 among French Canadians and 1 in 100 in some Jewish population
Its an inherited lipid disorder with very high LDL cholesterol readings ( 180 - 300 ) where 85% of males will have an heart attack ( often fatal ) by age 65 unless aggressively treated.
Max dose Statins are the first line of treatment but high TG's ( over 200 ) especially with low HDL cholesterol ( under 40 ) represent additional residual risk
So ..how to lower the TG's ...you can't use Lovaza because of the risk of raising LDL , Fibrates are not advised and may be ineffective anyway , don't use Niacin ...so whats left ... Vascepa
As I said ..high TG's in this case represent residual risk ...but if you are 63 and facing an 85% chance of a heart attack by age 65 , unless aggressively treated ( Medscape stats ) ..you throw everything at the problem including a Mediterrean diet , no red med / no dairy ..eat a lot of Salmon ( yes a little DHA is ok for maintaining cell fluidity etc ), not smoking ...and oh yes ...early morning hikes
Thanks Jim and Boundbrook
Actually my wife ( Yale grad , PA in dialysis ) thought iobvates post was really funny .
. High TG's is very common among her patients and she is regularly prescribing Lovaza or Vascepa and fighting with pharmacy committee at her hospital for coverage . ( whether Lovaza or Vascepa depends on several factors the most important ones being LDL levels , TG levels and how much the patients insurance will cover )
High TGs and low blood serum EPA levels are recognized risk factors for those on dialysis ...heart attacks and arrithmyias being a major cause of death in her patients .
I'm not advocating Vascepa for a health person whose only problem are TG's around 200... However for those with diagnosed lipid disorders , prior CV events , diabetics , those on dialysis , those with low HDL and high TG etc ....the research evidence is very compelling ....raising your EPA blood serum levels and reducing your TGs , inflammation and stabilizing arterial plaque .....reduces your risk of a heart attack .
Medical studies showing the benefit of lowering TG's ...suggest you visit the EPAdruginititaive site . The most famous study is the Jelis trial ..see "Relationships between plasma fatty acid composition and coronary artery disease " to quote " the risk of major coronary events was significantly decreased ( 20% ) in the group with high ( 150 ug/ml or more ) on treatment plasma EPA concentration compared with that in the low ( less than 87 ug/ml ) group "
Of course the benefits were even greater in the sub group of high TG and low HDL ..which is where I'm at.
So you are wrong ...there are numerous studies showing the benefits of lowering high TG's particularly for diabetics , those starting dialysis , those with a history of coronary events and those with low HDL combined with high TG.
The Cardiologist I see at UCSF specified at target of 135 for my TG's ( as well as LDL below 100 and HDL over 40 ) ..I've achieved that by using Crestor, Zetia and Vascepa ...I'm right at 40 on my HDL
A lipid panel costs me $45 ..once every six months ...most of my communication with my Cardiologist and MD is by email
With the Amarin coupon Vascepa costs me the same as PlusEPA.
OmegaVia is cheaper but is not regulated by the FDA as a drug so its quality and quantity vary
Well I will try not to descend to your level of disrespect and answer some of your questions
1) Off label prescription . Vascepa is an FDA approved drug ( with no box warning ) which means that MD's have some flexibility in how they prescribe it . They are free to prescribe to patients who they think may benefit even if its is not for the primary approved indication.
They can not prescribe dietary supplements as these are not FDA approved drugs
2) I'm 63 and was diagnosed in 1985 with hetero familia hypercholestremia and mixed dyslipidemia .
My primary concern since 1985 was how to lower my LDL cholesterol since it was at 285 in 1985.
Beginning in late 2010 my MD was warning me that despite max dose Lipitor my lipid profile was not in target range and that I faced a high risk of a heart attack in my 60's
There was also a developing awareness of the importance of the HDL /TG ratio as an indicator of risk ...it was not all about LDL levels . My HDL levels were around 30 , my TG levels around 200 ...this 7 to 1 ratio was considered a significant risk indicator which lead me to look for something that could lower my TG's without raising my LDL cholesterol ....that was AMR101 at the time ...now known as Vascepa
Lowering Tg's is a lot easier then raising HDL cholesterol
I'll continue on next page
Met ..funny but unfortunately true. If there was ever a drug to approve for wider use pending Outcome results Vascepa has to be it ...
So far today I've written to 2 Cardiologists and 1 MD about my results , asking them to consider the synergistic benefits of EPA for their patients on Statin drugs
Rydad ...my apologies I thought you were responding to me . I think I'm the most excited about the synergistic benefits of purified EPA with Statin.
IMHO anyone on Statin drugs should also be on EPA and that EPA should be Vascepa if they can afford it or can get insurance coverage
The challenge is ..how to get the FDA to bend a little and approve wider use especially for diabetics and those with low HDL/ high TG's.
If that were to happen it would be a major support to Amarins business and stock price.
I'll waste a minute of my day responding to your post .
There are real people out here with lipid disorders and family histories of early death from heart attacks . Some of us research our condition and read different web sites like Medscape , The Heart.org , the EPAdrug inititive site and even Ihub and Yahoo message boards .
I've met people from these boards .
My lipid panel results and a record of my meds are always avaliable for anyone that wants to pay a notary in SF ( or sth Marin county ) to verify.
I encourage the use of EPA for anyone "at risk " and believe an FDA approved drug is better then a dietary supplement ...however I acknowledge that dietary supplements may offer a lower cost ( and lower quality ) option for those who can not get Vascepa with insurance coverage or by using Amarins coupon
I'm a big believer in using purified EPA to reduce my risk of a heart attack . I've used PlusEPA , Omega Via EPA 500 and Vascepa and will stick with Vascepa as long as its reasonably priced .
If I could not afford Vascepa I would use Omega Via ...PLusEpa is a rip off IMHO
Regarding Omega Via vs Vascepa ...as my pharmacist said when I asked her why I couldn't just take the dietary supplement version " We want you to take an FDA approved drug ( Vascepa ) because dietary supplements vary by quality and quantity "
Hi Zmaninmd ...yes muscle cramps can be a big issue with Statin drugs . If I start cramping ( leg cramps ) I skip a dose and like you I exercise at least 3 times a week. I'm also on a non red meat , non dairy diet and don't smoke
Hat Tip to Williams who long ago pointed out the syngeristic benefits of using EPA with Statin drugs ...my lab test indicate that effect and thats my real take away .
Everyone taking a Statin will benefit from taking high quality , purified EPA...and if you can get Vascepa at reasonably prices , thats the way to go .
AS some on this board may know , I have a family history of heart disease , participated in a cardiovascular clinical trial , taken Statin drugs at the max doses since 1985 and have provided blood for research at the UCSF Adult Lipid clinic.
Over the past 3 yrs I have experimented with different Statin drugs , Niacin and various Omega 3 fish oils...with blood test on average ever 4- 6 months
Today I had a lipid panel run ...the results were the best ever
The drugs I am on are max dose Crestor , max dose Zetia and 3 gms daily of Vascepa .
It is this COMBINATION that has , for me , produced the best results
The Crestor and Zetia work well reducing LDL cholesterol but I need the Vascepa to bring my TG's down to target range of 135. The Vascepa also seems to contribute to lowering my LDL to its lowest pt ..98 ..ever recorded. The Vascepa is an "off label " prescription.. Could I have achieved this using the dietary supplement Omega Via with the Crestor and Zetia ...possibly but I prefer to use an FDA approved and monitored drug provided its reasonably priced .
This combination IMHO works for those with mixed dyslipidemia and hetero famila hypercholestremia .
Vascepa ( or the less expensive and lower quality Omegia Via ) has far more applications then just the very high TG market .
As always, my lipid panel results are available to anyone that wants to pay for a Notary in SF to verify them
Hi Nuke ...well I'm into fruits and nuts ( Mediterranean diet ) but I'm certainly no flake :) Yes I do live in Marin County
You had an interesting post about push back from insurers
That's my read also ... Patients may be able to get off label scrips but increasingly will need the Amarin coupon plan to make Vascepa reasonably affordable.
We appear to be largely confined to the very high TG market ( Marine indication ) until FDA expands approval for diabetics and those with a combination of high TG / low HDL cholesterol ...there is a lot of research to support covering these last 2 groups mentioned ..
Other then that we wait for some Reduce It interim data
Thanks for that note on the CME
Not sure if the AZN funding means much ....but it's nice to see Drs Ballantyne and Bays promoting the use of Omega 3's to reduce CVE risk ....particularly the Omega 3 ( Vascepa ) that does not raise LDL cholesterol .
Note how they warned against relying on dietary supplements
Blood draws ( lipid panels ) are very important for those at elevated risk .
We need to know if the drugs we are taking ( in addition to diet and life style changes ) are working .
I only have lipid panels run every 6 mths now and pay far less then the $ you quoted
The lipid panels are not solely to monitor the effect of Vascepa ...it covers the effect of Crestor ( a Statin drug ) and chk blood sugars among other risk markers
My Vascepa prescription is off label
You are correct in that insurance did not cover but with Amarins coupon it cost me $132 a month
It costs me about $2.80c a day more then Omegia Via ....I don't mind paying the extra since Vascepa is FDA regulated as a drug ( Omegia Via as a food )