CONVERSATIONS FOR THE HEART – What is a statin drug and do I need it?
WHAT DO STATINS DO
Statin drugs are more than cholesterol lowering medications. They can also lower inflammation (irritation) in the body.
Statins are best used to reduce cardiovascular disease and mortality in those who are at high risk. Especially as a secondary prevention in people who have documented blood vessel disease. The ASTEROID trial showed shrinkage of plaque in arteries while on statin therapy. Examples of statin drugs include: atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin and pitavastatin.
WHO SHOULD TAKE A STATIN
Statins are standard of care for treatment of heart disease and other vascular disease such as stroke and peripheral vascular disease (poor blood flow in other arteries such as aorta, carotids and leg arteries). They have the most benefit in high risk groups with documented blood vessel disease, for prevention of a second event, and in people with very high cholesterol (LDL over 190) for primary prevention of heart disease. They are recommended for diabetics age 40-75 with LDL cholesterol of 70-190 mg/dl because of the high risk of heart and blood vessel disease in diabetes.
There is controversy using statins when trying to prevent vascular disease in the first place. The balance of benefit and risk should be discussed with your health care provider.
There can be side effects with statin use. For example, statins can cause muscle pain (myalgia) and, although rare, inflammation of muscles (myositis). This can result in decreased exercise tolerance and possibly impact the health of the spine because of muscle weakness in the back. There can be increased risk of developing diabetes, especially in women, which may be dose related. Liver function should also be monitored. Finally, there is a possibility of interactions with other medicines.
Other possible side-effects that have been reported can include effects on memory, headaches, neuropathy, sleep disturbance, sexual dysfunction, GI side-effects, and cataracts.
If someone is at high risk, the need for medication to prevent heart disease events often outweighs the chance of serious side effects. But it is critical to have good information before taking any medicine. If you start a medicine don’t forget that a healthy lifestyle and nutritional support are still very important.
Q: “WOW, this is a lot to take in, should I really take these medicines?”
A: These medicines are very important for people with high risk.
If you have had a heart event, stroke or have very high cholesterol, then you fall into the high-risk group.
If the medicine causes side-effects, there are options to use different statins, a different dosing regimen or combine with a different medicine. It is very important to discuss this with your doctor. Don’t just stop your medicines before talking with your doctor. If you are at high risk and stop your statin, you may be at higher risk for more events.
Q: “What if I haven’t had a heart event and my cholesterol is not that high. How do I know if I am potentially higher risk?”
A: There are different ways to calculate risk, all are an estimate. A famous one is the Framingham Risk Calculator which estimates a 10-year risk of cardiovascular disease. You can go on line and enter your gender, age, cholesterol level, blood pressure and smoking history and a score is produced. This is only a basic risk score and it can miss other factors that can lead to a heart attack such as irritation or Inflammation in body. A different scoring system may be more accurate. It is called a Coshec Risk Score* and this is recommended by Dr. Mark Houston. Dr. Houston is an expert in hypertension and has vast knowledge on the prevention and reversal of heart disease. Recommended reading by Dr. Houston: What Your Doctor May Not Tell You about Heart Disease.
*COSHEC risk score includes age, tobacco use, blood pressure, cholesterol, height, creatinine (kidney function), homocysteine (a heart risk factor), prior heart attack or stroke, LVH (the thickness of the heart muscle), diabetes, elevated blood sugar (in a non-diabetic).
Q: “What if I have risk, but have bad side effects from Statins. Is there anything I can do to protect my arteries?”
A: Fortunately there are many factors that can help heart health. Lifestyle can make a HUGE difference. My favorite approach is applying Functional medicine. This involves a detailed, scientific look at the big picture as it relates to not only the heart, but the entire body. What we eat, how we move, sleep, what kind of stresses we are under can hopefully be modified to allow better health. Although procedures and some medicines can be potentially life-saving, we need to look at what the body truly needs.
We don’t need to give up on acute care medicine but we can try to reduce chronic problems by creating the proper environment for correcting the underlying concerns.
It should be noted that the Framingham Risk Calculator is a basic heart risk calculator. For a more complete heart health assessment contact The Center for Optimal Health to schedule an appointment (517) 324-9400.
Dr. Alicia Williams is an Integrative Cardiologist at The Center for Optimal Health and offers cardiac screenings for athletes age 16 and older. Call (517) 324-9400 to set up your cardiac screening with Dr. Williams at The Center for Optimal Health in East Lansing, Michigan.
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