A few months ago, I asked a question at EmpowHer, regarding my borderline-high cholesterol. I was taking a medical exam for life insurance, and wanted to know how to lower my cholesterol within a short amount of time (2 weeks). Of course, I would like to keep it low for my long-term health, but I had a specific goal to achieve (and, if my cholesterol was "high enough" to put me in a higher life insurance category--not necessarily a diagnosable "high cholesterol", then in life insurance terms, I would be paying $50.00 per month more, for the remainder of the policy. Talk about incentive to make sure my cholesterol is at a normal range!)
I received some great advice on how to lower my cholesterol in a short-amount of time, but was also disturbingly told I "should get a prescription for statins" as there are "few side effects". I was surprised that someone would tell me I "should" get a prescription, when I don't have the condition (high cholesterol) that the drug is indicated for, and do not know any other factors about my health. This made me wonder why it is readily assumed that statins are for "everyone", statins are "safe", and statins "should be prescribed" without forethought or inquiry into a person's other health conditions or risk factors.
In learning more about statins, I read some interesting information that I wanted to share. Statins have proven time and time again that they are effective for lowering cholesterol...but they are not a "one size fits all" drug, and may not be for everyone.
Similar to many people, my cholesterol is typically on the higher side, and I can lower it with consistent, almost-daily exercise, by eating the recommended "heart healthy" foods, as well as other making other lifestyle modifications. High cholesterol runs in my family, and I have realized that I am one of those people that have to actively work at keeping it down consistently, or it creeps back up.
Although my cholesterol may be higher than others who exercise and "eat right" in similar ways, after reading the current research, I found out that taking a statin drug is not for me. Why? The statin drugs have been touted as a "magic pill" for quite some time, but as with any drug or supplement, there are some side effects, and some people who do not tolerate this drug well.
Additionally, there are different doses of this drug, and the correct dosage depends on how many other risk factors you have for heart disease (high cholesterol is only one risk factor). The NY Times discussed a study published in The New England Journal of Medicine (November, 2008), noting that in addition to testing for cholesterol, "a blood test for C-reactive protein, or CRP, measures inflammation, and studies have shown that patients with high CRP are at higher risk for heart attack, even if they have normal cholesterol."
I think this is an important distinction: people are not prescribed statins to lower their cholesterol; they are prescribed statins to ultimately lower their risk for heart disease and heart attack, through the mechanism of lowering cholesterol.
To answer the question: are statins for everyone? A great article from the Mayo Clinic, Statins: Are these cholesterol-lowering drugs right for you? explains who statins are for:
If you have:
- "High total cholesterol (at or above 240 mg/dL)
- High "bad: cholesterol (at or above 130 mg/dL)
- Plus...other factors for cardiovascular disease:
* Family history of high cholesterol or cardiovascular disease
* Lifestyle
* Blood pressure
* Age
* General health
* Presence of diabetes
* Excess weight
* Smoking
* Peripheral vascular disease"
"If the only risk factor you have is high cholesterol, you may not need medication because your risk of heart attack and stroke is probably already low."
Plus, there are even some cholesterol-lowering supplements (source: Mayo Clinic) that may work for people who do not require statins. Here are a few examples (please talk with your doctor before adding any supplements to your diet, as some may interact with other drugs/supplements you are taking):
- ground flaxseed (0 to 50 grams a day, stirred into cereal or yogurt, or mixed into the batter for baked goods)
- fish oil (2 to 4 grams a day)
- Beta-sitosterol- found in some butter and margarine, such as Promise Activ- (2 tablespoons of margarine a day)
I am still critical of most supplements, but along with my daily vitamin, I do add ground flaxseed to my morning yogurt, and use the specific butter on my english muffin.
The article suggests other supplements that may be helpful at reducing cholesterol, but some researchers are bringing up questions: is there a baseline on "how low is too low" for cholesterol? Cholesterol has a purpose and a function in our bodies, and there have been scarce reports from individual patients who claim that they are experiencing side effects, including muscle pain, liver damage, digestive problems and neurological effects (most notably memory loss).
This is interesting to note that although most people do not experience side effects, there was discussion this year about adding statins to drinking water:
- EmpowHer: Debate about Adding Statins to Water
- NY Times: Statins in Our Water? Not So Fast
I agree with the sentiments from the above articles, that "no so fast" to adding statins to drinking water is correct; there have not been enough long-term studies on statins, and although they are effective at lowering cholesterol, there are other means of accomplishing heart health for the majority of people (via the old-fashioned heart-healthy diet and exercise). Additionally, statins are not recommended for women who are pregnant, or for infants, as it could be harmful for these, and other, groups of people.
As summarized in the article, Cholesterol Contrarians, "...treatment with these drugs [statins], is appropriate, 'only in the context of already recommending diet, exercise and smoking cessation. Statin therapy is not a replacement, but an adjunct for preventive care'."
If you and your doctor have decided that statins are not for everyone, specifically you, then how can you lower your cholesterol?
Top 5 Lifestyle Changes to Reduce Cholesterol (source: Mayo Clinic):
1. Lose excess weight. I know, easier said than done, but if you are carrying excess pounds, even losing 5-10 pounds can make a profound impact.
2. Eat fat! No kidding...just the "healthier" kind in moderation. This includes low-fat cream cheese, nuts, olive oil and omega-3-rich foods, such as almonds, walnuts and some fish! (oh yeah..and the "supplement" flaxseed is great, too!)
3. Daily exercise. Go for a walk. Dance in your living room. Throw a frisbee. Do housework. Instead of going on a dinner/movie date, explore your city or town by foot. Instead of watching your kids swim in the pool..join them!
4. Quit. Smoking, that is. If you need help, let us know!
5. If you choose to drink alcohol, do so in a low-risk manner. What is low-risk? For most healthy adults, that equals no more than one serving of alcohol per hour, and not more than 3 daily for men; not more than 2 daily for women. What to drink instead? There are great summertime cocktail recipes all over the internet that are refreshing (and "look" like an alcoholic beverage, if you can about that sort of thing). Be sure to carry bottled water with you, and fill it up frequently--alternate your alcoholic beverages with water (water alone...not as a mixer..ha ha), to keep hydrated, keep calories down, and to drink in a low-risk manner for better heart health.
Further Reading:
-NY Times: A Call for Caution in the Rush to Statins (November 2008)
- EmpowHer Video: What are the Risks and Benefits of Statins?
- Statins Can Help Prevent Second Stroke (May 2009)
- Substitute for those who can't take statins (June 2009)
- Many Who Should Use Statins Don't (April 2009)