Are You A Candidate For A Statin
Guidelines from the American College of Cardiology and American Heart Association recommend statin therapy for:
- Secondary prevention in people with established atherosclerotic cardiovascular disease.
- People with an LDL cholesterol level of 190 milligrams per deciliter or higher, due to a genetic condition.
- People with diabetes ages 40 to 75 with an LDL level over 70 mg/dL and no atherosclerotic cardiovascular disease.
- Non-diabetic adults ages 40 to 75 with a 20% or greater likelihood of developing atherosclerotic cardiovascular disease in the next 10 years .
- Non-diabetic patients ages 40 to 75 with an LDL level of 70 to 189 mg/dL and a 10-year ASCVD risk of 7.5% to less than 20% if the risk estimate and presence of certain risk-enhancing factors* favor treatment.
* These factors include a family history of ASCVD, LDL levels persistently 160 mg/dL, triglyceride levels persistently 175 mg/dL, chronic kidney disease, ethnicity, inflammatory diseases, metabolic syndrome, and results of high-sensitivity C-reactive protein, lipoprotein, and apolipoprotein B. Note: The guidelines recommend considering coronary artery calcium scoring for people at intermediate risk in whom a decision about starting statin treatment remains uncertain.
Should I Take A Statin If My Cholesterol Is Normal
Yes, no, maybe. It depends on your other risk factors.
Some people still benefit from a statin even if their LDL is ânormal.â For example, you may want to consider statins if you have had a heart attack or you are at high risk for having another heart attack or even a stroke. Also, if you have diabetes and are between 45 and 75 years old, you are at high risk for cardiovascular disease.
In certain people, statins could also help to reduce the risk of heart disease and stroke, even if LDL cholesterol levels are low. For example, if you have high levels of inflammation in your arteries, statins can lower this inflammation and, in turn, lower the risk of cardiovascular disease. This is true even if your cholesterol levels are normal.
Effect On Lomitapide On Lipid And Lipoprotein Levels
The effect of lomitapide on lipid and lipoprotein levels has been studied in patients with Homozygous Familial Hypercholesterolemia. The pivotal study was a 78-week single arm open label study in 29 patients receiving treatment for Homozygous Familial Hypercholesterolemia . Lomitapide was initiated at 5mg per day and was up-titrated to 60mg per day based on tolerability and liver function tests. On an intention to treat basis, LDL-C was decreased by 40% and apolipoprotein B by 39%. In patients who were actually taking lomitapide, LDL-C levels were reduced by 50%. In addition to decreasing LDL-C levels, non-HDL-C levels were decreased by 50%, Lp by 15%, and triglycerides by 45%. Interestingly HDL and apolipoprotein A-I levels were decreased by 12% and 14% respectively in this study. Follow-up revealed that the decrease in LDL-C could be sustained for a prolonged period of time .
The above studies demonstrate that lomitapide decreases LDL-C, non-HDL-C, triglycerides, and Lp levels.
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Mechanisms Accounting For Bile Acid Sequestrants Induced Lipid Effects
Bile acid sequestrants bind bile acids in the intestine, preventing their reabsorption in the terminal ileum leading to the increased fecal excretion of bile acids . This decrease in bile acid reabsorption reduces the size of the bile acid pool, which stimulates the conversion of cholesterol into bile acids in the liver . This increase in bile acid synthesis decreases hepatic cholesterol levels leading to the activation of SREBPs that up-regulate the expression of the enzymes required for the synthesis of cholesterol and the expression of LDL receptors . The increase in hepatic LDL receptors results in the increased clearance of LDL from the circulation leading to a decrease in serum LDL-C levels . Thus, similar to statins and ezetimibe, bile acids lower plasma LDL-C levels by decreasing hepatic cholesterol levels, which stimulates LDL receptor production and thereby accelerates the clearance of LDL from the blood.
The mechanism by which treatment with bile acid sequestrants improves glycemic control is unclear .
Statins And How Statins Work
Doctors also prescribe, usually if lifestyle changes are falling short, drugs like statins. Brand names include Lipitor, Crestor, Mevacor, Pravacol, and Zocor. Statins have been clearly shown to reduce blood cholesterol and prevent atherosclerosis, or heart disease. They work by reducing the livers production of cholesterol. They block an enzyme called HMG CoA Reductase that the liver uses to make cholesterol.
But other things are happening in the liver that statins do not affect. In addition to producing cholesterol, the liver helps clear excess cholesterol from the blood. It has tiny receptors that capture LDL bad cholesterol particles that are floating around. Like vacuum cleaners, these receptors suck this excess cholesterol up and out of the blood, which means theres much less cholesterol seeping into our artery walls, building plaque.
The problem is, a diet full of saturated fats, trans fat, and dietary cholesterol reduces the number and effectiveness of these LDL receptors. And theres nothing statins can do to counteract this process.
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Does Lowering Your Cholesterol Protect You From Ever Having A Heart Attack
Not necessarily. Since their arrival in the 1990s in Americans medicine cabinets nationwide, statin drugs have indeed proven very effective for reducing high LDL levels, and they do slow the progression of cholesterol-filled plaques. But sadly, the #1 cause of death in Americans taking statins to lower their elevated LDL levels is still heart attacks, states Kimberly Gomer, MS, RD, LDN, one of the many faculty who teach wellness education and nutrition workshops at the Pritikin Longevity Center.
Will Statins Increase My Risk For Diabetes Or Complicate My Existing Diabetes
This risk is true to some extent, but its wildly exaggerated.In fact, there are good data to show that people who have problems with their blood sugar or who have diabetes benefit most from statins. Even though their blood sugar may go up slightly, the added risk is significantly offset by the reduction in heart disease risk that a statin can provide.If youre already at risk for developing Type 2 diabetes, or if you have prediabetes, you may monitor your blood glucose more closely after starting a statin. But exercise and weight loss have been shown to lower the risk of developing diabetes in those with borderline blood glucose levels, regardless of statin use.
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What Are The Risks
Before you start taking statins, tell your provider if:
- You are pregnant, plan to become pregnant, or are breastfeeding. Pregnant and nursing mothers should not take statins.
- You have allergies to statins.
- You are taking other medicines.
- You have diabetes.
- You have liver disease. You should not take statins if you have certain acute or long-term liver diseases.
Tell your provider about all of your medicines, supplements, vitamins, and herbs. Certain medicines may interact with statins. Be sure to tell your provider before taking any new medicines.
Overall, there is no need to avoid moderate amounts of grapefruit in the diet. An 8 ounce glass or one grapefruit can be safely consumed.
Regular blood tests will help you and your provider:
- See how well the medicine is working
- Monitor for side effects, such as liver problems
Questions To Ask Your Doctor
If youâre not sure why your doctor prescribed statins to lower your cholesterol, ask at your next appointment.
- Why do you think I need a statin?
- What will it do for me?
- Based on my specific health, what might I gain from taking one and what are my risks?
- Could a statin interact with any medicines or supplements Iâm taking?
- When will I know if this drug is working?
- Can I take a supplement instead of — or along with — a statin to lower my cholesterol?
- What supplements or treatments will ease side effects?
Miller tells his patients to look at statins like a daily vitamin to boost health. “In many ways, thatâs what it is,” he says, “and itâs the only one that we know that works so well to improve cholesterol and lower cardiovascular risk.”
Michael Miller, MD, director, the Center for Preventive Cardiology, University of Maryland Medical Center, Baltimore.
Patrick McBride, MD, MPH, director, preventive cardiology program and cholesterol clinic, the University of Wisconsin School of Medicine and Public Health, Madison, Wis.
David Kiefer, MD, assistant clinical professor of medicine, University of Arizona, Tucson.
American Heart Association, Atlanta. Diet and Exercise Key for Treating High Triglycerides: New AHA Statement
Current Opinion in Lipidology, Lowering LDL-Cholesterol Through Diet: Potential Role in the Statin Era, 2011.
Consumer Reports: Heart Supplements: Proceed with Caution.
FDA: “Important safety label changes to cholesterol-lowering statin drugs.”
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What Is The Pritikin Diet
The Pritikin diet significantly reduces saturated fatty acids trans fatty acids , and dietary cholesterol. It also increases dietary fiber in the form of natural, nutrient-rich foods like fruits, vegetables, whole grains, and beans. This is the healthiest way to lower cholesterol, points out cardiologist Ronald Scheib, MD, physician and educator;at the Pritikin Longevity Center in Miami, where the Pritikin Program has been taught since 1975.
Statin Risks And Benefits
Are statins safe? For most people, the answer is a resounding yes,;according to a 2014 Johns Hopkins meta-analysis of 20 years worth of published research. It showed that the risks of long-term use of statin drugs are low and the potential benefits are very high. Researchers combed through hundreds of papers that had studied statins since 1994 to determine the evidence of side effects.
Their review, published in;British Medical Journal,;found an increase in the risk of muscle aches. There was also a modest risk of elevated blood glucose, which can tip some people into developing type 2 diabetes. Whats unclear is whether those people, who also had other risk factors for diabetes, would have developed the condition anyway. Statins dont cause memory loss or cataracts, as has been claimed in the past. For most at-risk patients, the benefits far exceed the risks, the researchers concluded. Of course, if you notice any unusual effects after beginning statin therapy, tell your doctor.
We know a lot about statins because theyve been around for a long time and taken by so many people, Blaha says. The scale clearly tips to benefits in most at-risk patients.
Why did my doctor prescribe statins if my cholesterol is normal?
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Statin Use During A Heart Attack
If youve had a heart attack or are dealing with any other type of acute coronary event, such as interventions like bypass surgery or angioplasty, chances are your physician will prescribe a statin during and immediately after the event, and for good reason. It is generally accepted in the medical community that statins may have some value independent of lowering LDL cholesterol, probably anti-inflammatory in nature.
But doctors do not have clear answers to the following: What statin is best? What dosage? How long should the patient be on it? Usually, high doses are prescribed immediately after the event and are then tapered to doses necessary to maintain target values .
There is much about statins we physicians do not know, states Dr. Ronald Scheib, MD, FACC, FACP, former Chief of Section of Cardiovascular Medicine at the Miami Heart Institute. We do know that toxicity is a clear danger.
Why Have I Been Offered Statins
Having a high level of LDL cholesterol is potentially dangerous, as it can lead to a hardening and narrowing of the arteries ;and;cardiovascular disease .
CVD is a general term that describes a disease of the heart or blood vessels. It’s the most common cause of death in the UK.
The main types of CVD are:
- coronary heart disease;;when the blood supply to the heart becomes restricted
- angina;;chest pain caused by reduced blood flow to the heart muscles
- heart attacks;;when the supply of blood to the heart is suddenly blocked
- stroke;;when the supply of blood to the brain becomes blocked
A doctor may recommend taking statins if either:
- you have been diagnosed with a form of CVD
- your personal and family medical history suggests you’re likely to develop CVD at some point over the next 10 years and lifestyle measures have not reduced this risk
Find out more about when statins may be recommended.
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What Statins Dont Do
Its also important to keep in mind that statins address just one risk factor for heart disease high cholesterol levels. There are many other risk factors that statins do not touch, like high blood sugar, insulin resistance, belly fat, high blood pressure, and high triglycerides .
To attack all these risk factors, your best bet is a healthy lifestyle like Pritikin, points out Dr. Danine Fruge, Medical Director at Pritikin.
Mechanisms Accounting For The Ezetimibe Induced Lipid Effects
NPC1L1 is highly expressed in the intestine with the greatest expression in the proximal jejunum, which is the major site of intestinal cholesterol absorption . Knock out animals deficient in NPC1L1 have been shown to have a decrease in intestinal cholesterol absorption . Ezetimibe binds to NPC1L1 and inhibits cholesterol absorption . In animals lacking NPC1L1, ezetimibe has no effect on intestinal cholesterol absorption, demonstrating that ezetimibeâs effect on cholesterol absorption is mediated via NPC1L1 . Thus, a major site of action of ezetimibe is to block the absorption of cholesterol by the intestine . Cholesterol in the intestinal lumen is derived from both dietary cholesterol and biliary cholesterol ; thus the majority is derived from the bile . As a consequence, even in patients that have very little cholesterol in their diet, ezetimibe will decrease cholesterol absorption. While ezetimibe is very effective in blocking intestinal cholesterol absorption it does not interfere with the absorption of triglycerides, fatty acids, bile acids, or fat-soluble vitamins including vitamin D and K.
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Statins Lower Heart Attack Stroke Risk In People At Average Risk
Editors note: This is one in a 10-part series of the top medical research advances of 2016;as determined by the American Heart Association.
Millions more people worldwide may benefit from cholesterol-lowering statins after a global study showed the drugs help reduce heart attacks and strokes in people at moderate risk. The risk fell slightly further when patients also took blood pressure drugs.
Medications to lower blood pressure have been shown to reduce the risk of heart disease in people with elevated blood pressure and those at high risk, and statins have been shown to benefit those at high risk. But a group of researchers wanted to know if treating each condition alone or simultaneously might prevent heart attacks and strokes in an ethnically diverse group of average-risk people without cardiovascular disease.
The study, called Heart Outcomes Prevention Evaluation-3, or HOPE-3, found that the dual low-dose therapy is the best way to reduce cardiovascular risk in older people with elevated blood pressure and nearly normal cholesterol but who had another risk factor such as smoking or obesity. The results were published last April in The;New England Journal of Medicine in three papers, and the research was selected as one of the American Heart Associations top 10 heart and stroke science advances of 2016.
HOPE-3s findings reinforce 2013 guidelines from the AHA and American College of Cardiology that recommend statins for more people.
Mechanism Accounting For The Mipomersen Induced Lipid Effects
Apolipoprotein B 100 is the main structural protein of VLDL and LDL and is required for the formation of VLDL and LDL . Familiar Hypobetalipoproteinemia is a genetic disorder due to a mutation of one apolipoprotein B allele that is characterized by very low concentrations of LDL and apolipoprotein B due to the decreased production of lipoproteins by the liver . Mipomersen, an apolipoprotein B antisense oligonucleotide, mimics Familiar Hypobetalipoproteinemia by inhibiting apolipoprotein B 100 production in the liver by pairing with apolipoprotein B mRNA preventing its translation . This decrease in apolipoprotein B synthesis results in a decrease in hepatic VLDL production leading to a decrease in LDL levels.
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Cholesterol Levels In Dialysis Patients
In a study of dialysis patients, those with higher cholesterol levels had lower mortality than those with low cholesterol.51 Yet the authors claimed that the inverse association of total cholesterol level with mortality in dialysis patients is likely due to the cholesterol-lowering effect of systemic inflammation and malnutrition, not to a protective effect of high cholesterol concentrations. Keeping an eye on further funding opportunities, the authors concluded: These findings support treatment of hypercholesterolemia in this population.
Reducing Heart Disease Naturally
One thing that this study does show is that cardiovascular disease is complicated.
The study also brings to light another fact about cholesterol drugs are not the only way to lower your LDL levels.
Most doctors who prescribe statins for high cholesterol will also recommend that patients exercise more and eat healthier foods.
But more hospitals and doctors offices are starting to promote lifestyle changes as a way for patients to reduce their risk of cardiovascular disease and LDL levels using diet and exercise alone.
Often this approach involves a whole food or plant-based diet rich in vegetables, fruits, whole grains, beans, legumes like chickpeas and lentils, healthy fats like those in olive oil and avocado, and dairy alternatives.
For many, this diet will be a challenge to switch to. But there is a growing body of research on its benefits.
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Who Needs To Take Statins
In 2018, experts including the AHA and American College of Cardiology released guidelines recommending that doctors prescribe statins to people in the following four high-risk groups:;
- People who have cardiovascular disease
- People with a high LDL cholesterol level
- People who are between 40 and 75 years of age and have type 2 diabetes
- People between 40 and 75 years of age who have at least a 7.5% risk of getting cardiovascular disease in the next 10 years
Statins are usually prescribed to people who have had a heart attack or stroke, or are at higher risk for having one, such as smokers and people with high blood pressure or diabetes.;
Statins may also be prescribed for people who have high cholesterol levels as a result of genetics. This inherited condition called familial hypercholesterolemia causes some people to produce too much LDL, or bad, cholesterol. Children with FH may also be prescribed statins.