Truths About Statins And High Cholesterol
For every drop of scientific evidence that statins are safe and effective, there is a tidal wave of misinformation. Our patients are concerned about statin side effects theyve heard about from family or friends, or read about on the Internet.Statins are the gold-standard for high cholesterol treatment. Theyre a powerful medication, and theyve been proven to save the lives of many men and women living with or having a high risk of heart attack or stroke.But if statins are so effective, why are some people afraid to take them?As with any medication, there are risks associated with taking statins, but the benefits far outweigh the risks for the vast majority of high-risk patients.In an effort to put statin side effects into context and provide honest, scientific answers about statins and their use, weve put together a list of common questions our patients ask us:
What Can I Expect In The First Few Days Or Weeks Of Starting A Statin
Most people don’t feel any different or notice any side effects after starting a statin. Some people may feel muscle aches and pains in the first 6 months. In rare cases, statins can cause serious problems with your muscles and liver. Tell your doctor immediately if you have signs of problems with your muscles and;liver such as muscle pain, muscle tenderness or weakness, dark coloured urine, yellowing of the skin or eyes, sharp pain in your stomach area.;;
Mistake 8: You Take Statins With Grapefruit Juice
Maybe you want to get a healthy start to your day and take your statins with breakfast. But if your breakfast includes grapefruit juice, you may want to check with your doctor first. According to Cleveland Clinic, grapefruit juice contains a chemical that can interfere with your bodys ability to break down certain statins.
Additional reporting by Katherine Lee
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Mistake 2: Youre Only Focusing On Ldl Cholesterol Levels
While its good to know what your so-called bad LDL cholesterol number is, that doesnt give you the complete picture, and numbers alone do not tell the story. Doctors order a blood test to look at your lipid panel, which consists of your high-density lipoprotein cholesterol, LDL cholesterol, triglycerides, and total blood cholesterol .
To evaluate your risk for cardiovascular disease, doctors will also consider other risk factors, such as your age, family history, and whether you have other health conditions related to heart disease, such as diabetes and high blood pressure, according to the American Heart Association .
Other Approaches To Prevention
The USPSTF has made other recommendations relevant to the prevention of CVD in adults, including aspirin use for the prevention of CVD,32 screening for coronary heart disease using electrocardiography,33 use of nontraditional risk factors in CVD risk assessment,12 screening for high blood pressure,17 screening for abnormal blood glucose levels and type 2 diabetes mellitus,34 interventions for tobacco smoking cessation,18 behavioral counseling to promote a healthful diet and physical activity for CVD prevention in adults,35 and screening for and management of obesity in adults.36
This recommendation statement was first published in JAMA. 2016; 316:19972007.
The Other Considerations,Discussion,Update of Previous USPSTF Recommendation, and Recommendations of Others sections of this recommendation statement are available at .
The USPSTF recommendations are independent of the U.S. government. They do not represent the views of the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or the U.S. Public Health Service.
Read the full article.
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What Is High Cholesterol And Who Should Care
High cholesterol raises your risk of atherosclerosis, which is the buildup of plaque in your arteries. Arteries are the blood vessels that supply nutrients and oxygen to your body.
Atherosclerosis, in turn, raises your risk of developing cardiovascular disease, or disease of the heart and blood vessels.
Statins are prescription medications that lower your cholesterol levels. Examples include atorvastatin, simvastatin, rosuvastatin, and pravastatin. Statins block an enzyme that normally allows your body to make cholesterol. By blocking the enzyme, statins lower the amount of cholesterol in your blood.
Lovastatin, the first statin available in the U.S., was approved by the Food and Drug Administration in 1987.
Lowering cholesterol with a statin is beneficial for people who:
- Already have cardiovascular disease, like a heart attack or stroke
- Are at high risk for cardiovascular disease due to diabetes or other reasons
- Have very high cholesterol levels
How Should You Take Statins
Your body makes cholesterol at night. Short-acting statins like simvastatin and the immediate release formulations of fluvastatin and lovastatin should be taken at bedtime. Other statins can be taken at any time.
Talk to your healthcare provider about potential drug interactions and whether changes need to be made to either the statin or the other drug.
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Effect Of Evinacumab On Clinical Outcomes
There are no cardiovascular outcome studies.
Homozygosity for loss-of-function mutations in ANGPTL3 is associated with significantly lower plasma levels of LDL-C, HDL-C, and triglycerides . Heterozygous carriers of loss-of-function mutations in ANGPTL3, which occur at a frequency of about 1:300, have significantly lower total cholesterol, LDL-C, and triglyceride levels than noncarriers . Moreover, patients carrying loss-of-function variants in ANGPTL3 have a significantly lower risk of coronary artery disease . Additionally, in an animal model of atherosclerosis treatment with evinacumab decreased atherosclerotic lesion area and necrotic content . Taken together these observations suggest that inhibiting ANGPTL3 with evinacumab will reduce cardiovascular disease.
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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What Is Fda Doing
We are requesting revisions to the information about use in pregnancy in the prescribing information of the entire class of statin medicines. These changes include removing the contraindication against using these medicines in all pregnant patients. A contraindication is FDAs strongest warning and is only added when a medicine should not be used because the risk clearly outweighs any possible benefit. Because the benefits of statins may include prevention of serious or potentially fatal events in a small group of very high-risk pregnant patients, contraindicating these drugs in all pregnant women is not appropriate.
FDA expects removing the contraindication will enable health care professionals and patients to make individual decisions about benefit and risk, especially for those at very high risk of heart attack or stroke. This includes patients with homozygous familial hypercholesterolemia and those who have previously had a heart attack or stroke. Statins are safe to use in patients who are not pregnant but may become pregnant.
Summary Of Recommendations And Evidence
The USPSTF recommends that adults without a history of cardiovascular disease use a low- to moderate-dose statin for the prevention of CVD events and mortality when all of the following criteria are met: they are aged 40 to 75 years; they have 1 or more CVD risk factors ; and they have a calculated 10-year risk of a cardiovascular event of 10% or greater. B recommendation.
Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Clinical Summary of the USPSTF Recommendation
Population
note: For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, go to .
ACC/AHA = American College of Cardiology/American Heart Association; CVD = cardiovascular disease; HDL-C = high-density lipoprotein cholesterol; LDL-C = low-density lipoprotein cholesterol; USPSTF = U.S. Preventive Services Task Force.
Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Clinical Summary of the USPSTF Recommendation
Population
note: For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, go to .
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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.
The New Strategy For Statins: Should You Be Taking One
Guidelines for taking cholesterol-lowering drugs now target overall risk rather than cholesterol values.
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Discuss all of your risks for heart disease with your doctor to determine if you should take a statin. |
For anyone who’s had a heart attack or a stroke, or has chest pain with exercise or stress , taking a statin makes a lot of sense. These cholesterol-lowing drugs slash deaths from cardiovascular disease by 20%. Doctors also recommend statins for most people with diabetes, because they face two to four times the risk of heart disease than people without diabetes.
But what about everyone else? For years, doctors prescribed statins based largely on cholesterol test results, aiming to cut total cholesterol to under 200 milligrams per deciliter of blood , and LDL to under 100 mg/dL. But in November, new guidelines on statin use issued by the American Heart Association and the American College of Cardiology proposed a major change to that strategy.
“The new guidelines shift away from a target-driven approach to a risk-driven approach,” says Dr. Reena Pande, a cardiologist at Harvard-affiliated Brigham and Women’s Hospital and an instructor at Harvard Medical School. Instead of striving to reach a specific cholesterol value, doctors should consider a person’s entire cardiovascular risk profile, she explains.
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Statin Use In Adults Aged 40 To 75 Years
Nineteen RCTs evaluated the effects of statins vs. placebo or no statins in adults aged 40 to 75 years without known CVD. Most of the trials, including the recently published HOPE-3 trial,8 enrolled participants based on an elevated LDL-C level, a diabetes diagnosis, or at least 1 CVD risk factor. Use of low- or moderate-dose statins was associated with a reduced risk of all-cause mortality , cardiovascular mortality , ischemic stroke , heart attack , and a composite cardiovascular outcome .6
Among the study populations, the proportion of CVD events prevented was similar across age, sex, race/ethnicity, lipid level, and other risk factor categories.6 Among trials that stratified participants according to a baseline global cardiovascular risk score, similar relative risk estimates were observed among those classified at a higher vs. lower CVD event risk.10,23
In the absence of other risk factors, adults with an LDL-C level greater than 190 mg/dL may still fall below the risk threshold for statin use for CVD prevention. As noted previously, these persons were generally excluded from the prevention trials evaluating the effects of statin use on health outcomes, because expert opinion strongly favors intervention for these individuals. It is possible that the relative risk reduction in this group is higher than in adults with a lower LDL-C level and that the absolute benefit is greater than would be predicted from a risk calculator.24
New Statin Guidelines: Everyone 40 And Older Should Be Considered For The Drug Therapy
The U.S. Preventive Services Task Force on Sunday issued new guidance;for the use of cholesterol-busting statin drugs. The report greatly expands the universe of people who should be screened to see if they need the medication to everyone over age 40 regardless of;whether they have a history of cardiovascular disease.
The recommendations also support the position of the American College of Cardiology and the American Heart Association, which;in 2013 radically shifted their;advice;from suggesting;that doctors focus on;the level of a patients low-density lipoproteins or bad cholesterol to looking at a more comprehensive picture of risk;based on things such as weight and blood pressure, as well as lifestyle factors.
People with no signs, symptoms, or history of cardiovascular disease can still be at risk for having a heart attack or stroke, said;Kirsten Bibbins-Domingo, who chairs the task force.
The task force, which is made up of independent experts but commissioned by the government, concurred after a;comprehensive review of the evidence on the topic determined that a broader;evaluation of;risk is needed. But it puts a greater emphasis on age than the ACC and AHA did in determining who might benefit from;the medication in preventing heart attack or stroke. It is also slightly more conservative when it comes to determining the benefits of taking the medications, which include Lipitor, Crestor and Zocor.
This post has been updated.
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Should You Take A Statin Even If Your Cholesterol Is Normal
Consider this option after determining your personal risk with your doctor.
Statin drugs reduce LDL cholesterol, the type that puts you at risk for cardiovascular disease. But even if your cholesterol is not particularly high, it could still be smart to consider starting a statin.
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Should You Take Statins To Lower Cholesterol Dr Ross Walkers Verdict
So, who should be on pharmaceutical therapy for their high cholesterol levels and are there any natural alternatives?
It is my opinion, backed up by solid scientific data, that the only people who significantly benefit from statin therapy to lower cholesterol are those with existing heart disease i.e. prior heart attack, stent or coronary bypass surgery or a coronary equivalent related to atherosclerosis such as an ischaemic stroke or peripheral vascular disease.
The only other group where I believe statin therapy is indicated is in people with a high coronary calcium score that places them above the 75th percentile in their age group.
In my cardiology practice, if a 70-year-old male has a high cholesterol and a calcium score below 200, I certainly do not commence him on therapy but reinforce lifestyle principles and may suggest some natural alternatives, which I will detail later in this article. The average coronary calcium score for a 70-year-old female is 100. Again any score around or below this, in my view, does not justify statin therapy, regardless of cholesterol levels, without a prior history of cardiac issues. It is important to realise that a low calcium score does not give you 100 per cent protection against heart problems, but certainly means your risk is so much lower.
Let me make some important points about statins.
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You Should Get A Second Opinion On Statin Useand Heres Why
Im often called upon to render a second opinion on whether a patient should take a statin or not. The scenario is usually something like this:
A middle-aged patient undergoes a routine blood test and is told by their physician that they should take Lipitor, Crestor, Zocor, or any of the popular cholesterol-lowering drugs. Usually, its simply a matter of their having high cholesterol, the bad kind, or LDL .
As a result, more than one in five Americans between the ages of 40 and 75 already takes a statin to prevent an initial heart attack or strokesome unnecessarily.
The old guidelines were paint-by-number: Anyone with an LDL over 160 deserved cholesterol reduction; those with a single risk factor for heart diseasesuch as family historyearned a more stringent cut-off of 130; For those with 2 or more risk factors , the goal was 100 or less; For those with established heart disease, it was said to be imperative to lower LDL to 70 or less.;
All;diabetics are thought to be so prone to heart disease that they merit aggressive cholesterol-lowering, as are any individuals who have suffered strokes, heart attacks, or have undergone bypass surgery or coronary artery stenting.;
But lately, a new metric has been used to stratify risk for those without pre-existing heart disease, and to indicate the need for statins. It involves;a calculator;with plug-ins that is said to predict your 10-year risk of a cardiac eventif its 7.5% or more, youre told you should take a statin.;
Mistake 6: Youre Not Exercising Enough
Diet alone is often not enough. It should be combined with exercise, says Michos. When it comes to exercise, the equation is pretty simple: Being sedentary equals lower levels of HDL, according to the AHA. You can lower both cholesterol and high blood pressure by doing at least 150 minutes of moderate-intensity exercise, such as walking, bicycling, swimming, or even doing yard work, each week.
Even more good news: A review published in November 2018 in the journal BioMed Research International found that both low- and moderate-intensity aerobic exercise led to a significant reduction in total cholesterol, including LDL.
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