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How To Use Statins To Manage Cholesterol

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Are statins really a miracle drug for people at risk for heart disease? Should everyone take them? Dr. Suzanne Steinbaum, director of Women and Heart Disease at Lenox Hill Hospital, explains what you need to know about statins.

I'm Lisa Birnbach for Howdini. By now, you've probably seen about a million ads for anti-cholesterol drugs like Lipitor and Zocor. They will help lower cholesterol as we understand it, and they may even be helpful with other health problems, like diabetes. But as the ads always say, we feel we should ask our doctor if statins are right for you. And our doctor, in this case, is Suzanne Steinbaum, a cardiologist who specializes in women's heart disease at Lenox Hill Hospital in New York.

Dr. Steinbaum, what are statins?

Statins are a group of drugs that have been shown to decrease LDL cholesterol, which is the bad cholesterol, and actually increase a little bit the HDL cholesterol, the happy cholesterol.

Why aren't we all taking them as a matter of course?

I think at some point we might actually ask ourselves that question. Statins, in some way, seem to be a miracle drug. They not only change the cholesterol pattern but they actually decrease inflammation and stabilize plaques. We know heart disease is due to plaque formation inside of the arteries. There's cholesterol and inflammatory cells, and they all group together in this little mound, if you can picture it, inside of the artery.

When you have a heart attack, picture a pot of boiling water on the stove filled with soup. And inside that pot, all of those different particles-- cholesterol particles bubbling away, something called smooth muscle cells, inflammatory cells. And picture that pot covered with--

Mmm, yum!

No, no. Covered with Saran wrap. You cut the Saran wrap, and steam comes out, and particles come out. And that's what happens when you have a heart attack. Those statins stabilize that Saran wrap, keeps the bubbling down. It's an anti-inflammatory, along with being a lowering of cholesterol.

Are there bad side effects to statins?

It's very important to know that every medication can have a side effect, and it depends on you. Some people do get muscle aches with statins, and it's important to get your blood checked. The statins are metabolized by the liver, and the liver enzymes need to be checked, in the beginning, every six weeks. And if everything is OK, then they can be checked less often.

Eventually, if you find the right statin with the right formula, you can go on it indefinitely.

Absolutely. And it in fact may prevent the progression of that plaque formation.

But don't think of the statin as your excuse to not exercise.

A statin does not replace exercise.

I'm sucking up to you now.

A statin actually does not replace your need to eat well, either. You can't take your statin and go have a hamburger with cheese. It in fact is not the way it works. You need to continue to eat well and eat appropriately, in terms of a low fat, low cholesterol, high in fiber diet to actually prevent the onset and progression of heart disease.

Do people watching who think that they want to start on statin therapy, do they need to go to a cardiologist, or can their general practitioner put them on it?

Statins can be prescribed by anybody. But I think it's important that we understand what our risk factors are, and understand if, in fact, we might be at risk for the development of heart disease. When cholesterol is assessed, we don't just look at the LDL cholesterol, which is really when we put somebody on a statin. We look at multiple other components. The HDL cholesterol, the good cholesterol, we know is protective.

And in fact, a statin is not the best way to increase our cholesterol. I hate to say it, but exercise is the best way to increase the HDL cholesterol. Along with a vitamin that is called a niacin. Niacin, in certain formulations, are FDA-approved, and a prescription is required as well. That medication increases the HDL cholesterol and helps protect the heart.

The other thing is triglycerides. Now this type of lipid is actually something that's very directly related to our diet. If you have a diet filled with breads and pastas and simple sugars, triglycerides tend to go up. The best way to get triglycerides down is actually by eating a diet filled with lots of multigrains, and also substances that are high in antioxidants. Fruits, vegetables, legumes, all of these things. The Mediterranean-type diet is the best way to decrease triglycerides. But also, omega-3 fatty acids are very important, and can decrease triglycerides, increase HDL cholesterol, and also decrease inflammation.

Thank you so much.

You're very welcome.

For Howdini, I'm Lisa Birnbach.

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EmpowHER Guest

Please cite references for data showing statins decrease mortality in women. In addition, could you provide the NNT (number needed to treat) for any statin use in women? or men over the age of 65 who take statins for primary prevention? Or anyone who takes statins for primary prevention? How about the Number needed to Harm? Could you cite any of those statistics? You fail to mention the most recent studies indicating statin use is associated with development of type II Diabetes. This interview also fails to mention the very real evidence of severe myopathy (via muscle biopsy) which does occur WITHOUT increases in any measureable enzyme levels. All those muscle aches complaints in individuals who do not have abnormal enzyme levels can be (not often measured because of cost) associated with real changes in muscle structures.
Perhaps you could comb through the FDA ADR reports on statins before you advise about statins use, especially in a population for whom there is no evidence that they impact mortality and ARE associated with considerable adverse effects. In addition, you do not mention the genetic studies noting a relatively common (26 to 34%) prevalence of mutations in a gene, SLCO1B1*15 and (less common, 5-6%) SLCO1B1*5 that encodes the gene responsible for the transport protein that moves statins into the liver for Phase II detoxification , resulting in greatly increased plasma statin levels, due to inability to detoxify statins correctly. I feel you have provided less than accurate information, glossing over the ADRs which are real and can be, if not lethal, at least debilitating.
In addition, could you provide any COI's (conflicts of interest)? In the spirit of transparency. Mine is that YES, I feel I have suffered irrepairable damage from statins, the onset of a neurodegenerative disease. "Miracle drug"? Certainly not for me and the "primary prevention" for which I received Lipitor for 4 yrs.

December 3, 2011 - 8:08am
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