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    How low can cholesterol go and Are there reasons to stop taking Nicorandil
    An_252471 posted:
    Hello Sir/Madam,

    My Dad is 65 years old and he is a Type 2 diabetic and heart patient.
    Around 6 years ago he had a heart attack, an angiogram was done and he was diagnosed with the Tripple Vessel Disease and his angiogram report details are as follows:

    CAG : Three Vessel Disease, Moderate LV function
    CAD : Recent AWMI (Thrombolyzed)
    LMCA: Normal
    LAD: Type 3 vessel, proximal LAD normal, mid LAD shows 90% stenosis followed by diffuse 60-70% stenosis
    Diagonals: Major D1 - Ostial 70% stenosis
    LCX : small caliber vessel
    Marginals: not visualized
    RCA: Dominant, proximal RCA shows 60% stenosis, mid RCA shows 70% stenosis, distal RCA normal
    PDA/PLC: PLV - Diffuse plaquing. PDA-Minor plaquing.
    LV: Anterolateral hypokinesia, Fail LV systolic function, LVEF - 50%
    Final Diagnosis: CAD - Fair LV systolic function

    Since then he has been taking the following medications:

    Deplat - A 75mg+75mg 0-1-0 (clopidogrel)
    Atorva-EZ 0-0-1 (Atorvastatin + Ezetimibe)
    Cardace 2.5mg 1-0-0 (Ramipril)
    Metolar 50mg 1-0-1 (Metoprolol Tartrate)
    Nitrofix-SR 30mg 1-0-0 (isosorbide mononitrate)
    Nikoran 5mg 1-0-1 (nicorandil)

    Last week ago, when he went to see a cardiologist, his prescription was changed to the following:

    Deplat - A 75mg+75mg 0-1-0 (clopidogrel)
    Atorsave 0-0-1 (Atorvastatin)
    Cardace 2.5mg 1-0-0 (Ramipril)
    Tolol-XR 25 1-0-0 (Metoprolol)
    Nitrofix-SR 30mg 1-0-0 (isosorbide mononitrate)

    His recent lipid profile, sugar levels and blood pressure readings at the time he went to see the cardiologist are as follows:
    1. Fasting blood sugar: 97
    2. Postprandial blood sugar: 134
    3. Total cholesterol: 97
    4. Triglycerides: 88
    5. HDL Cholesterol: 27
    6. LDL Cholesterol: 43
    7. VLDL Cholesterol: 17
    8. Blood Pressure: 110/80

    Here are my questions to you:
    1. What are the potential resons for asking a patient to stop taking Nikoran? Last week, my dad was prescribed medication that
    does not include Nikoran (nicorandil).

    2. What are the potential reasons for changing from Atorva-EZ (Atorvastatin + Ezetimibe) to Atorsave (Atorvastatin)? Is LDL level of 43 too low to stop taking Atorva-
    EZ? Does Atorsave help in stopping further lowering of LDL? How low can LDL go?

    3. What are the potential reasons for changing from Metolar 50 mg to Tolol-XR (Metoprolol) 25?

    4. In a heart patient with tripple vessel disease what are the optimal cholesterol levels (LDL, HDL and Total)?

    Thanking you in advance.

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