How Low Can Ldl Go
Research done on cholesterol-lowering statins has shown that the risk of cardiovascular disease decreases at lower levels of LDL cholesterol.
But doctors havent known how low cholesterol can go and still reduce risk of heart problems and stroke.
One reason for this is that previous drug studies either didnt look specifically at outcomes for people whose LDL cholesterol dropped to very low or ultra-low levels.
Or if they did, there were not enough of those patients to make the statistical analysis useful.
So researchers from the FOURIER study reanalyzed the data with an eye toward these lower cholesterol levels. The results were published Aug. 28 in The Lancet.
The new analysis suggests that the benefits of lowering your LDL cholesterol continue to increase the lower you go, even at ultra-low levels, at least in terms of reducing your risk of developing heart problems or stroke.
There was also no increase in safety concerns for this group, compared with people whose LDL didnt drop as much.
However, there are some limitations.
Since researchers followed people for only two years, they dont know if the ultra-low LDL levels translate to a lower risk of dying over the long run.
Some health problems also only show up after taking a drug for years.
And lower LDL cholesterol levels dont always mean an overall health benefit.
Who Should Take Statins
Estimates are that in addition to the people already taking them, another 15 million to 20 million people should be taking statin drugs based on their risk factors for heart disease. Your doctor can do a simple blood test to determine the amount of cholesterol in your blood. If you have high levels of LDL cholesterol, you have a greater chance of heart disease, especially when there are other factors that increase your risk. Based on your overall risk, your doctor may recommend you take statins to help lower your cholesterol by a certain amount.
However, not all cholesterol is bad. It’s good, for instance, to have high levels of HDL cholesterol. HDL cholesterol prevents plaque buildup in the arteries by transporting the bad cholesterol out of the blood to the liver. From there, it is eliminated from the body.
You Dont Need To Avoid Eggs And Seafood
Some foods are high in cholesterol but are fine to eat in moderation, as long as your overall diet is low in saturated fats. For example:
- Egg yolks a single egg yolk contains 200250 mg of cholesterol, which is almost the uppermost recommended daily intake . However, reducing egg intake is probably not important for healthy people with normal blood cholesterol levels.
- Seafood prawns and seafood contain some cholesterol, but they are low in saturated fat and also contain healthy omega-3 fatty acids. Seafood is a healthy food and should not be avoided just because it contains cholesterol. However, avoid fried and battered seafood.
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The I Newsletter Cut Through The Noise
The National Institute for Health and Care Excellence recommends statins are offered to people whose ten-year risk of cardiovascular disease, including heart attack and stroke, is greater than 10 per cent. This individual risk is worked out using factors such as ethnicity and social background, and whether the person smokes or has diabetes.
But Paula Byrne and John Cullinan, from the National University of Ireland Galway, and Susan Smith, from the Royal College of Surgeons in Ireland, now argue that the benefits of statins are unclear for many people. They said research has found that statin use can be associated with a rare but serious increased risk of muscle problems, diabetes and haemorrhagic stroke.
They pointed to a study which found a 65-year-old man prescribed statins, who smokes, has high cholesterol and blood pressure, but no heart disease, could lower his absolute risk of heart disease or stroke over the next decade from 38 per cent to 29 per cent.
However, a low-risk 45-year-old woman who does not smoke, but has high cholesterol and slightly raised blood pressure, would see her risk drop from 1.4 per cent to 0.8 per cent. They said this risk reduction is so small it may not justify taking a daily pill.
The researchers also looked at the introduction of 2016 European guidelines recommending more people be given statins.
How Long Does It Take Cholesterol To Go Down
People who need to use medications such as statins to lower their cholesterol should see their cholesterol levels fall quickly.
These medications may work in a matter of weeks, and they generally work to a larger degree than lifestyle changes.
However, because diet affects the levels of cholesterol in the body, doctors commonly recommend that people make changes to their diet and lifestyle in addition to taking medications.
Making simple changes to the diet and lifestyle can help reduce cholesterol.
These changes vary depending on how strictly a person adheres to their diet, as well as other factors, such as exercise and weight loss.
Some dietary changes may cause minor reductions in cholesterol in as little as
Dietary and lifestyle changes and medications can all help lower blood cholesterol levels.
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Your Personal Risk Of Heart Attack Or Stroke
Remember: If your health care team suggests that you take a statin, its all to help lower the chances that you will have a heart attack or stroke caused by atherosclerotic cardiovascular disease .
ASCVD develops because of a buildup of sticky, cholesterol-rich plaque. Over time, this plaque can build up and narrow the arteries.
Your care team may have already talked with you about how a risk calculator can be used to find your risk of developing ASCVD or having a heart attack or stroke. This calculator factors in things like:
- Your age
- Systolic blood pressure
- If you smoke
- If you have diabetes
Your care team may also consider other factors that play a role or affect your risk. Because your risk can change over time, its important to keep talking with your care team about what steps you can take to stay healthy as you age.
Keep in mind that making lifestyle changes in addition to taking a statin or other medication can help protect your heart and improve your overall health.
Myth: I Dont Need Statins Or Other Medicines For My Cholesterol I Can Manage My Cholesterol With Diet And Exercise
Fact: Although many people can achieve good cholesterol levels by making healthy food choices and getting enough physical activity, some people may also need medicines called statins to lower their cholesterol levels. Guidelinesexternal icon also suggest that other medicines in addition to statins may be needed to help control cholesterol.2
People who may need statins or other medicines to manage cholesterol levels include the following:
- People with familial hypercholesterolemia or people with very high levels of bad cholesterol. FH is a genetic condition that causes very high LDL cholesterol levels beginning at a young age. If left untreated, cholesterol levels will continue to get worse. This greatly raises the risk for heart disease, heart attack, and stroke at a young age.
- People with cardiovascular disease . People with CVD may already have narrowed arteries because of too much plaque. Medicines that lower cholesterol may help reduce the risk for heart attack or stroke.
- People with diabetes.Type 2 diabetes lowers HDL or good cholesterol levels and raises bad cholesterol levels. This combination raises your risk of heart disease and stroke.
Other groups of people may also need medicines to manage their cholesterol, including people who have a high risk for CVD. Always talk to your health care provider about the best ways to manage your cholesterol.
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What Are Statins Used For
Having high levels of ‘bad’ cholesterol in the blood can increase the risk of cardiovascular disease, such as heart attack and stroke. Statins are used to lower LDL cholesterol, and this helps lower the risk of cardiovascular disease.
Statins are considered the most effective group of cholesterol-lowering medicines available and work by blocking cholesterol production in the liver.
Do Statins Have Side Effects
Many people who take statins experience few or no side effects.
One of the side effects some people report is muscle pain. The Medicines and Healthcare products Regulatory Agency estimates two in every 1,000 people taking statins will experience muscle pain per year . It can be hard to work out if the statin is causing the muscle pain. Lots of people get muscle pains for other reasons anyway. In some studies, more people got muscle pain while taking a statin when they knew they were taking it, compared with when they didnt know if they were taking a statin. You can read more in this.
If you do experience muscle pain you should tell your doctor. You can also report any side-effects you feel you are getting to theYellow Card Scheme. This helps the MHRA track the rate of possible side effects.
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Myth: Eating Foods With A Lot Of Cholesterol Will Not Make My Cholesterol Levels Go Up
Fact: It can be complicated. We know that foods with a lot of cholesterol usually also have a lot of saturated fat. Saturated fats can make your cholesterol numbers higher, so its best to choose foods that are lower in saturated fats. Foods made from animals, including red meat, butter, and cheese, have a lot of saturated fats.
Instead, aim to eat foods with plenty of fiber, such as oatmeal and beans, and healthy unsaturated fats, such as avocados, olive oil, and nuts. Learn more about healthy diets and nutrition at CDCs nutrition, physical activity, and obesity website.
Talk with your health care provider about ways to manage your cholesterol. Learn more about medicines to lower cholesterol.
Foods That Affect Risks For Heart Disease Stroke And Type 2 Diabetes
Patients need to understand that high cholesterol is governed by your genetics,” said Nissen. “You cant pick who your parents are. Diet alone can decrease your bad cholesterol by 15 percent, but that is not the 40-50 percent reduction that we look for.”
When someone stops taking a statin prescription, cholesterol levels go back up, along with the risk for a heart attack or stroke. After his emergency situation, Pinhas, a father of two, understands that. He’s taking statins again and feels better.
“I go to the gym when I can and I take my meds,” said Pinhas. “I experience some muscle aches but it’s tolerable. I know I have to take these for the rest of my life. We’ll see.”
Dr. Shamard Charles is a physician-journalist for NBC News and Today, reporting on health policy, public health initiatives, diversity in medicine, and new developments in health care research and medical treatments.
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Which Statin Will Lower Your Cholesterol
Lipitor , Zocor , Crestor , and other statins can dramatically lower levels of artery-clogging cholesterol in the blood, an ability that makes them hugely popular in our cholesterol-rich country. Heart researchers have estimated that these drugs could save 1,000 lives each week for every 10 million high-risk heart disease patients who take them.
One study of nearly 20,000 patients found that, after a heart attack, taking a statin can prevent the risk of death within one year by 25%. Among patients who don’t even have cardiovascular disease, taking a statin preventively can reduce the risk of a major coronary event like heart attack by about 30%.
When Denise Foley, 57, of Philadelphia, went through menopause, her cholesterol shot up from 160 to 240. Her doctor warned her that that number, along with her family history of heart disease, put her at risk for a heart attack or stroke. But she didn’t want to take heart medication. “I really wanted to lower my risk without drugs,” she says. “I lost 30 pounds, I exercised, and I went on a vegetarian diet. But I just couldn’t budge it.”
Statins lower cholesterol in two ways: They encourage the liver to clear LDL from the blood, and they block an enzyme that the body needs to make new cholesterol.
More on heart drugs
How Can I Avoid Statin Side Effects
Reviewed byDr Colin Tidy
I am on 40 mg of atorvastatin and my joints are so sore. It used to be in my muscles for nine months but the last three months my knees and fingers have been really hurting. I am in my 60s and play tennis but that and the stairs are becoming a problem. I am also getting a lot of nausea. Can l reduce the amount of statins l take? I have hardening of the arteries and minor blockages.
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Can You Lower Bad Cholesterol Too Much
Reviewed byDr. Victor Marchione, MD.Written byMohan GarikiparithiPublished onFebruary 12, 2020
Cholesterol levels are a top concern among Americans focused on heart health. Whether youre using statin medications or lifestyle measures to reduce it, can LDL get too low?
Your body needs cholesterol, even the bad stuff. Low-density lipoprotein, or LDL, is the stuff doctors are concerned about. Small particles can accumulate on arterial walls and cause atherosclerosis, which is the main reason it is such a major risk factor in heart disease.
But you need LDL for healthy hormone levels and cell membranes it allows your cells to communicate with each other. If levels get too low, are these important functions impeded?
That can be controversial.
The American Heart Association and other organizations suggest elevated LDL should be brought down to 70 milligrams per deciliter . Other research, however, has shown it can go much lower without health implications.
On the other hand, there is work to suggest that when LDL gets too low, it may influence how high-lipid organs, like the brain, function. There has also been evidence that aggressive statin treatment can boost the risk of osteoporosis.
But those studies may say more about aggressive statin use than low cholesterol. For example, people with genetic conditions that have very low levels of LDL do not have the same issues.
Statin Drug And Food Interactions
Some foods and medications donât mix well with statins and can make side effects worse:
- Grapefruit juice, which has chemical that can change the way your body breaks down statins
- A drug for irregular heart rhythms called amiodarone
- Gemfibrozil , a cholesterol drug
- Protease inhibitors, a type of HIV medication that includes saquinavir and ritonavir
- Some antibiotic and antifungal drugs, such as clarithromycin and itraconazole
- Certain medications, such as cyclosporine, that lower your immune system activity
There are other medications that can cause problems if you take them with statins. You should tell your doctor about all over-the-counter or prescription drugs, herbal supplements, or vitamins that you use.
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Mistake : You Forget To Take Your Medication Or Have Stopped Altogether
Drugs to treat high cholesterol, including statins, have a proven impact on cholesterol levels and may prevent heart attack in people with coronary heart disease. But according to an article published in May 2018 in the journal Vascular Health and Risk Management, not taking statins as prescribed was linked to a significantly higher risk of cardiovascular problems and even death.
The article cites reviews showing medication compliance problems worldwide:
- One Italian study examining the effectiveness of statins found that only 61 percent were still taking their meds as prescribed after 3 months.
- A Canadian study found that as many as 60 percent of patients who had experienced acute coronary syndrome, such as a heart attack, stopped taking their statin within 2 years of hospitalization.
- Discontinuing statins is estimated to add a staggering $44 billion to healthcare costs in the U.S.
According to the Vascular Health and Risk Management article, researchers theorize that noncompliance may be due to a combination of factors, including cost, infrequent visits with cardiologists, concerns about side effects, and forgetting to take the medication. They also note that statins may be discontinued at a higher rate than other medications because high cholesterol is a symptomless condition with infrequent tests compared with something like diabetes, which requires constant monitoring of blood sugar levels.
Serious Side Effects Of Statins
Statins are linked to a few rare but potentially serious side effects, including:
- Myositis, which is inflammation of the muscles. The risk of muscle injury increases when certain other medications are taken with statins. For example, if you take a combination of a statin and a fibrate — another cholesterol-reducing drug — the risk of muscle damage increases greatly compared to someone who takes a statin alone.
- Elevated levels of CPK, or creatine kinase, a muscle enzyme that when elevated, can cause muscle pain, mild inflammation, and muscle weakness. This condition, though uncommon, can take a long time to resolve.
- Rhabdomyolysis, extreme muscle inflammation and damage. With this condition, muscles all over the body become painful and weak. The severely damaged muscles release proteins into the blood that collect in the kidneys. The kidneys can become damaged trying to eliminate a large amount of muscle breakdown caused by statin use. This can ultimately lead to kidney failure or even death. Fortunately, rhabdomyolysis is extremely rare. It happens in less than one in 10,000 people taking statins.
If you have any unexplained joint or muscle pain, tenderness, or weakness while taking statins, you should call your doctor immediately.
Some studies link statin use with birth defects. Doctors advise pregnant women not to use these drugs.
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