A reader writes:
Dr. Lasater, I recently saw my primary care doctor for an annual physical and health review. He said that my cholesterol has remained high even though I have carefully followed his earlier recommendations to eat healthier. He is concerned as well because both of my parents had heart attacks in their 60s. He gave me a prescription for one of the so-called statin drugs (I believe it was atorvastatin), saying that I should start this and take it every day, apparently forever. However, I have heard that this class of drugs is very unsafe and that everyone should avoid them. Yet I know that high cholesterol is a big risk factor, and I of course don’t want to have a heart attack. What would you suggest I do? Thank you.
First, I want to commend you for having a regular visit with your doctor to discuss your health in general and to assess your cardiovascular risk in particular. You did not mention if your doctor had addressed the question of testing your cholesterol particle number that I had addressed a couple of months ago in this column, but in any case he is concerned enough about your risks to prescribe the statin drug that you mentioned. You and he were doing the right thing by having you first try to improve the cholesterol picture by eating healthier, but when this doesn’t work, prescribing a statin drug is usually the thing that one then needs to do if cholesterol numbers remain high. This class of medications works primarily in the liver to reduce the amount of cholesterol that the body – in particular, the liver – produces. That’s right – most of the cholesterol in our blood is made by the body, with only a relatively small percentage actually coming from the food we eat. Nevertheless, improving one’s diet by eating less saturated fat, less sugar and starchy carbohydrates, and increasing the amount of whole grains, fiber, fruits and vegetables in one’s diet can improve one’s cholesterol situation dramatically. In my practice I am a strong proponent of the Mediterranean diet, which has an overwhelming amount of medical evidence behind it that it reduces one’s risk of heart disease significantly.
But if dietary changes do not lower one’s risk sufficiently, then taking a statin drug is usually a good idea for most people. Several years ago I heard a professor from one of the top medical schools state that, in the history of medical science over the last 500 years, the developments that have saved the most lives worldwide are, in order, 1) vaccines, 2) antibiotics, and 3) statin drugs! Each year the statins save hundreds of thousands of lives worldwide. However, every physician that prescribes them will admit that the statins are not perfect and that there can be side effects, which can in some cases become severe. But the vast majority of those who take them have very few side effects, and usually just minor ones such as muscle soreness; those patients who develop severe side effects can usually be predicted in advance. The muscle soreness that some patients experience can in many cases be avoided if the person takes vitamin D3 and CoEnzyme Q10.
There are about six or seven statin drugs on the market in the U.S.; while they all work in essentially the same way, the differences among them are such that any one particular statin drug may be better tolerated than the others, although this varies from patient to patient. In general they can be expected to reduce a patient’s bad cholesterol by 25 to 50%, although this too varies. If the patient’s cholesterol-based risk has not come down sufficiently, a change to a higher dose and/or a stronger statin may then be needed. In some cases to add a second cholesterol-lowering medication, called ezetimibe, which helps cut down on cholesterol reabsorption from the small intestine. The combination of a statin and ezetimibe is a very good choice, since cholesterol absorption tends to increase when one takes a statin alone.
My advice then is for you to follow your doctor’s recommendation and to start the statin medication, preferably with supplementation with good doses of vitamin D3 as well as with CoEnzyme Q10. As I had mentioned in my previous article about cholesterol particle testing, it is quite important to make sure that the particle number, and not just the LDL cholesterol (the so-called “bad cholesterol” number) reaches a safe level.