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How low can cholesterol go and Are there reasons to stop taking Nicorandil
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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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