Lowering Cholesterol May Not Lower Cardiovascular Mortality
The rare occurrence of CHD in isolated, rural societies such as Tukisenta, New Guinea has been attributed to low cholesterol levels. However, it is equally plausible that the diets and lifestyles of these individuals may protect them from CHD. While we may never be certain if low cholesterol or a healthy lifestyle are responsible for preventing CHD in these societies, there is ample evidence that lowering cholesterol does not consistently lower CHD mortality. Reducing cholesterol blood levels by reducing dietary saturated fats is commonly recommended, but an exhaustive review and meta-analysis of 72 dietary studies concluded that reduced consumption of saturated fat does not reduce cardiovascular mortality. Many drugs such as niacin, fibrates, and bile acid sequestrants can lower cholesterol levels, but the recent AHA/ACC guidelines on cholesterol concluded that these drugs do not lower CHD mortality rates. Moreover, the results of cholesterol-lowering statin trials, as will be discussed and analyzed later, do not consistently lower mortality rates. Consider also the dramatic mortality benefit of the Mediterranean diet in the Lyon Diet Heart Study which was achieved without a reduction in cholesterol levels. Thus, the hypothesis that lowering cholesterol lowers mortality from CHD is not supported by many clinical research studies.
How Do Doctors Decide Who Is Prescribed A Statin
In preventive cardiology, its up to us to help patients avoid suffering from a sudden, serious cardiovascular event, such as a heart attack or stroke, or a long, grueling ailment such as atherosclerosis . We determine on an individual basis which patients have the greatest need and who would benefit most from taking statins. We weigh these benefits against the known risks for each patient before we consider prescribing the medication.
Like all medications with risks and benefits, there are specific guidelines we follow to ensure that we prescribe statins only to people who really need them.
The American College of Cardiology and American Heart Association developed these rational guidelines in 2013 after carefully reviewing the decades of published studies about statins. First, we determine a patients overall risk of cardiac disease, taking into account their cholesterol levels as well as other risk factors such as blood pressure, smoking history, diabetes, age, and sex.
There are four general categories recommended to determine who is at high risk for a cardiovascular event, such as a heart attack or stroke.
We may recommend statins for other people, even if they dont fit in these categories. For example, if a close relative has suffered a heart attack and your own cholesterol levels are getting higher regardless of lifestyle improvements, we may recommend that you take a statin.
Side Effects Of Statins
Many people who take statins experience no or very few side effects.
Your doctor should discuss the risks and benefits of taking statins if they’re offered to you.
The risks of any side effects also have to be balanced against the benefits of preventing serious problems.
A review of scientific studies into the effectiveness of statins found around 1 in every 50 people who take the medicine for 5 years will avoid a serious event, such as a heart attack or stroke, as a result.
Find out more about the side effects of statins.
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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.
How Statin Drugs Protect The Heart
More than 200 million people around the world take statin drugs for theirheart health. Shifting ideas about the risks and benefits of statins overthe years, however, have left some new patients confused about whetherthese drugs are rightor safefor them.
Traditionally, statins were viewed as purely cholesterol-lowering drugs. So it made sense just to use them for people with high cholesterol, explains Johns Hopkins cardiologist Michael Blaha, M.D. But weve learned that they also benefit people with lower levels of cholesterol who are at a high risk of heart disease. So we now think of statins as risk-reducing drugs.
This dramatic change in thinking means that people who once were not candidates for statins are now prescribed them to lower their risk of heart attack and stroke.
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Statins Can Cut Heart Attacks In Moderate
Results from the HOPE-3 trial, presented on the opening day of the 65th Scientific Session of the American College of Cardiology, suggest cholesterol-lowering statins could have preventive benefits in broader groups of patients than previously thought.
Taking statins can prevent heart attacks and strokes in patients at moderate risk for heart disease, but the same cannot be said for blood pressure medication, according to findings from a large trial presented today at the 65th Scientific Session of the American College of Cardiology in Chicago.
Results from the HOPE-3 trial, which involved 12,705 patients, were also reported today in 3 separate papers in the New England Journal of Medicine.1-3 While both statins and therapy to lower blood pressure have been shown to reduce cardiovascular events in patients with known risk of heart disease, HOPE-3 set out to gauge whether these drugs could prevent heart attacks and strokes in a broader population.
While treatment with cholesterol-lowering rosuvastatin brought a 24% reduction in CV events, with an absolute reduction of 1.1 percentage points, treatment with candesartan plus hydrochlorothiazide did not significantly lower risk in the overall group, researchers reported.
Our approach, which used a combination of moderate doses of 2 blood pressure lowering-drugs plus a statin, appears to produce the biggest bang, in terms of reducing events, with few side effects.
When Are Statins Used
Statins are used if you are at risk of having a stroke or heart attack this is checked at a cardiovascular or heart risk assessment.
|You’ve had a stroke or heart attack in the past||
Your dose of statin will depend on your cardiovascular risk people with a lower cardiovascular risk will be on lower doses compared with people at higher risk.
Statin Effects On Muscles
These effects tend to be dose-dependent. That means they increase as your dose of statins increases. Because of this, they usually go away when statin dosage is lowered.
There are times when you may be at a for statin-related muscle symptoms. These include after:
- starting on statins for the first time
- increasing the dose of your statins
- taking another drug that interacts with your statins
Rhabdomyolysis is more likely to occur in people who are taking statins with other medications that carry a similar risk. In fact, its estimated that of cases of rhabdomyolysis related to statins are due to drug interactions.
Get Relief From Statin Side Effects
Your doctor may be able to suggest some ways to relieve the side effects you have with statins. These changes may help, but talk to your doctor first:
- Take a break from statins, which can help you know if the drugs are the cause of muscle aches or other side effects
- Try a different statin drug or dose
- Change your exercise routine gradually and skip intense workouts if youâre not used to them
- Try another type of medication to lower your cholesterol
- Take coenzyme Q10 supplements, which may stave off side effects in some people
The statin medications that are approved for use in the U.S. include:
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Who Can Take Statins
You might be prescribed a statin if you have heart disease or another disease of the heart and blood vessels, or if you are at risk of developing them in the next 10 years.
If you have high cholesterol
You should be offered a statin if you have high cholesterol and lifestyle changes havent been enough to bring it under control.
Depending on your cholesterol levels and how healthy you are otherwise, you and your doctor or nurse might want you to try to bring your cholesterol levels down with a healthy diet and lifestyle first, before starting statins.
If you are at risk of developing heart disease
You will probably be prescribed a statin if you are at high risk of developing heart disease or a disease of the blood vessels. For example, if you have:
American Heart Association News Stories
American Heart Association News covers heart disease, stroke and related health issues. Not all views expressed in American Heart Association News stories reflect the official position of the American Heart Association. Statements, conclusions, accuracy and reliability of studies published in American Heart Association scientific journals or presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect the American Heart Associations official guidance, policies or positions.
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Dont Wait For Another Sign: Talk To Your Doctor About Your Heart Disease Symptoms
If youre noticing one or more of these seven symptoms, then the best place to start is by making an appointment with a primary care doctor to have your heart checked out and tested.
Your primary care doctor can diagnose and treat hundreds of conditions. They can help you build your heart wellness by working with you to create a tailored treatment plan. And if specialist help is needed, your doctor can connect you with an expert in cardiology for more testing and treatment.
Theres no doubt that symptoms of heart disease can be concerning, especially if youre not sure whats behind them or what the next steps are. But answers, care and treatment are available to help keep your heart as healthy as it can be so you can live your best life.
Which Medications Or Foods Do Statins Interact With
Some medicines and foods affect the way your liver can process the statin, increasing the risk of side effects. Grapefruit is a common food that has this effect with statins. Having large quantities of grapefruit while taking simvastatin or atorvastatin can increase your risk of side effects. But, eating one serving of marmalade, no more than half a grapefruit or drinking no more than a standard glass of grapefruit juice each day, should not be a problem if you are taking statins. It’s best to allow 12 hours between having these foods and taking your statin dose, so if you take your statin in the evening have your grapefruit in the morning. Statins interact with a few other medicines, including some antibiotics so it is important that you check with your doctor before taking any new medicines.
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Get Medical Advice From Your Doctor Not The Internet
There is no reason to be afraid of taking statins if you are at high risk for heart attack or stroke. Whats really scary is the amount of inaccurate information out there that keeps so many people from getting the protection they need!
The risks and side effects associated with statins are real they arent zero, but theyre very small. However, the benefits of statins for high-risk patients are substantial, and theyre invisible. Patients often dont consider that they didnt have a stroke or heart attack last year theyre too busy living and enjoying their lives while the statin medication protects them behind the scenes.
Statins are not for everyone, and there are complementary ways to lower your risk for heart disease. But for high-risk patients, the benefits of statins far outweigh the risks, and statin medications have a very important role in protecting their hearts and their lives. Its vital that you get medical advice from a doctor instead of trusting potentially misleading information on the Internet.
Though statins are incredibly effective, there are many different forms of heart disease. Heart disease is still the No. 1 killer of men and women in our country, and the epidemic is spreading throughout the world. As long as the battle continues, well continue researching new ways to prevent and treat heart disease.
What Are The Signs And Symptoms Of High Cholesterol
High cholesterol generally doesnt have obvious symptoms, but it can increase the risk of serious health conditions if left untreated. Thats why its important to get a blood test and regular check-ups. If you are 45 or older , see your doctor for a cholesterol test as part of a Heart Health Check. If you have a family history of high cholesterol, speak to your GP about your heart disease risk.
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Statins Can Help Men Lower Their Risk Of Heart Attack And Stroke Yet Many Resist Them
Statins have been doing what they do lowering cholesterol to help prevent cardiovascular disease for more than three decades. Still, many people who could benefit from the drug don’t take it.
“Statins have a role in men’s health under the right circumstances,” says Dr. Randall Zusman, director of the Division of Hypertension at the Harvard-affiliated Massachusetts General Hospital Heart Center. “Yet, men who can benefit from statin therapy sometimes avoid it because they misunderstand how the drug works, including the nature and frequency of side effects, as well as the larger role statin therapy can take in managing their longer-term health.”
What Are The Benefits Of Statins
Statins inhibit the action of an enzyme thats responsible for cholesterol production in your liver. In the process, they significantly reduce LDL and total cholesterol, while also having beneficial effects on HDL cholesterol, triglycerides and inflammation. Some evidence suggests that high-intensity statin therapy may help to slow, and potentially reverse, the growth of artery-clogging atherosclerotic plaques. They may also make them less prone to rupture and cause heart attacks and strokes.
There are good data to suggest that the more LDL lowering we can achieve, the lower the risk of adverse cardiac events such as strokes and heart attacks, Dr. Laffin explains.
Although statins all belong to the same drug class, they differ in how potent they are and how much they can lower LDL cholesterol.
Your doctor will use a tool like the American College of Cardiology/American Heart Association risk calculator and other factors to gauge your long-term risk of atherosclerotic cardiovascular disease, determine if you need statin therapy, and if so, which one.
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How Do Statins Work
Statins get in the way when your liver is trying to make cholesterol. Like a good basketball player who doesnt let an opponent get the ball, statins dont let your liver have an enzyme it needs to create cholesterol. Your body makes 75% of your cholesterol, so helping it make less can make a big difference. The rest of your bodys cholesterol is from what youre eating.
Statins also help your liver get rid of more cholesterol.
Heart Rhythm Disturbances And Statins
The usual side effect of Statins on the heart is congestive heart failure based upon CoQ10 depletion, an inevitable consequence of all HMG-CoA reductase inhibitors.
More recently, however, reports are surfacing of cardiac arrhythmias associated with the use of statin drugs. These take the form of extra systoles of both atrial and ventricular origin, occasional bradycardia and runs of tachycardia’s of various types.
Although the energy depletion mechanism of heart failure is thoroughly documented by the work of cardiologist, Peter Langsjoen, that of the cardiac rhythm disturbances is much less well understood.
The heart is usually the first to feel statin associated CoQ10 depletion because of its extremely high-energy demands. Physicians are seeing this as cardiomyopathy and congestive heart failure but what of these new reports? What possible mechanism can explain them?
Most of us now know that Statins lower cholesterol through inhibition of the mevalonate pathway of cholesterol biosynthesis. An unfortunate and inevitable side effect of mevalonate blocking is interference of ubiquinone metabolism. The implications of this were well known to the pharmaceutical industry from the very beginning of statin development.
The following are a few of the adverse reports I have received on the subject of heart rhythm disturbances and statins.
It seems to me that the lipid modifying drugs may have a permanent effect upon ones body functions.
Duane Graveline MD MPH
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