Coronary Heart Disease

What kind of info are you looking for exactly? One drug's a Ca+ blocker, the other's a statin to lower cholesterol.

I'm not sure of the protocol for dropping the Diltiazem but if she can get her cholesterol under control via weight loss, exercise and dietary changes then getting rid of the statin is quite possible. Her dose right now is quite low although it's fairly normal to start on a lower dose then see if it needs to be adjusted.

^^^ And you say this knowing her lipid profile...?

He said the doctor said it's a possibility. It is. I didn't say that it's a given but it is quite possible. I've seen meds discontinued quite often simply because the person got their LDL, HDL and cholesterol under control to the point where their dose was tapered off and then stopped. I don't need to know her lipid profile to state that it is possible over time that this may be the case for her. What did I say that is so unbelievable?

Do you really want to post your mom's health info on the web? I wouldn't. whodini and I are both medical students and neither of us is going to give you medical advice (nor would I even if I were a licensed doc; not over the internet). If you want generic info or answers to basic questions I'm willing to try and answer them but you could probably get all the answers you need by visiting some respected websites such as those of the Mayo Clinic, Cleveland Clinic, eMedicine, etc. Going to Drugs.com or something similar will also give you information on her medications that you can read e.g. side effects. Better yet, discuss these issues with your primary medical doctor or cardiologist.

Is there any particular reason you want one? All drugs have side effects and there is likely a reason (sometimes just personal preference) why her doctor choose these meds. He's the expert at this point and I'm still just trying to learn. Weight loss and exercise would be the best. They can both increase her lipid profile and exercise, in particular, can have a positive effect on HDL (so can weight loss though) which has an actual protective benefit to the heart. In the same way that high LDL is bad in that it increases plaque formation, high HDL is good because it has the exact opposite effect i.e. it can remove plaques. I would also ask your doctor about taking fish oil supplements as studies have shown that they have a positive effect. They have different effects. It's not like taking two different blood pressure medications, for instance, where your pressure can then become too low leading to fainting, etc. The Diltiazem slows down the heart rate of the heart (useful in high blood pressure, angina [chest pain due to decreased oxygen to the heart] and some arrhythymias). It also has an effect of dilating the blood vessels which I'm sure is a good thing in this case. Simvistatin is for her cholesterol. It inhibits one of the enzymes that is used for making cholsterol in the body. If you block this, there is less of it to further increase the plaques on your mom's blood vessels. I think it also has an effect of stabilizing existing plaques so they don't break off as well. Not 100% sure of this and it may be another drug I'm thinking of. Again, not sure of the Diltiazem but it can interfere with the action of the statin.

Both diltiazem and grapefruit juice can increase the serum concentration of simvastatin. The likely mechanism for this interaction is inhibition of CYP3A4-mediated presystemic metabolism of simvastatin (hepatic first pass-metabolism). Since your mother was started on a very low dose of simvastatin, this may not be much of an issue, but it is worth noting. There can potentially be an increased risk of dose-related adverse effects due to the increased amount of the simvastatin available. There are some other HMG-CoA reductase inhibitors (aka statins) such as fluvastatin, pravastatin and rosuvastatin that are not a substrate of cytochrome P450-3A4 metabolism and would not have this potential interaction.

Her total cholesterol is fine, however her HDL is low (not good) and the ratio is also not great. Given that she already has CAD, I think adding a statin was clearly indicated. If she had no risk factors, it might have been reasonable to start with diet and excercise only and monitored for improvement.

Incorrect.

Low for a woman is below 50. Above 60 is preferred but she is perfectly within the normal range for HDL.

Her triglycerides are fine and so is her total cholesterol.

The biggest problem is her LDL which should ideally be less than 70 given her risk for further heart disease. However, it should definitely be less than 100 even though the goal for a "normal" person is less than 130.

OK. Her HDL is officially WNL, but certainly not optimal. Given her history of CAD, I don't think most cardiologists would be happy with it.