Cholesterol-lowering meds can reduce risk of heart disease
Open up a magazine and you’re likely to be bombarded with information, ads and articles about statins. These medications — Crestor, Lipitor, Zocor and others — have been called the latest wonder drugs. For years they’ve been used to reduce cholesterol, and studies have pointed to statins as an important tool in reducing the risk of a heart attack or stroke.
In addition to lowering cholesterol, in particular LDL cholesterol, statins prevent the manufacture and buildup of plaque in those at risk for a heart attack or stroke. They also lower the risk of cardiac disease in those who already have plaque, possibly by stabilizing the plaque so it is less likely to break off the artery wall and travel through the bloodstream causing a cardiac event. Statins even have anti-inflammatory properties, and studies are in progress to see if they can help older patients fight off infection.
At least 32 million Americans are on a statin, according to a 2011 study. And 26.4 million more Americans should take a statin to help prevent heart attacks and heart disease, according to 2013 guidelines from the American College of Cardiology and the American Heart Association. Many of these additional individuals do not have cardiovascular disease but are at risk of developing it in the future due to genetics and lifestyle factors like smoking and weight.
How statins work
Statins can help when diet and lifestyle factors aren’t enough, says Neil Stone, MD, professor of medicine at Northwestern University’s Feinberg School of Medicine and lead author of the 2013 guidelines.
“Statins are the best cholesterol-lowering drugs we have,” Stone says. “Statins have played a major role in reducing the risk of heart attack and stroke because they lower cholesterol. They specifically reduce the low density lipoprotein (LDL) fraction, which carries about two-thirds of the cholesterol in the blood.”
Statins first came into use in the late 1980s, and they have been rigorously tested throughout the ensuing decades. They work by blocking an enzyme that controls the pathways of making cholesterol, especially LDL “bad” cholesterol, explains George Nijmeh, MD, a cardiologist at DuPage Medical Group.
So how do you know if you need a statin? The first step is to visit your doctor and review your cholesterol numbers.
The doctor will look at other factors as well, including age, gender, race, family history of cardiovascular disease or stroke, blood pressure and whether you smoke. The doctor will then enter this information into an online calculator, which will help determine your risk for a heart attack or stroke over the next 10 years.
This is the time for an open discussion with your doctor to determine if lifestyle changes (like stopping smoking or starting a healthier diet) are sufficient to lower your risk or if you should take a statin.
Statins can help when diet and lifestyle factors aren’t enough.”
If a patient wants to try diet and exercise before starting statins, Nijmeh is supportive. “We can work on blood pressure, smoking, diet, exercise … it’s a discussion,” he says. “Some patients say no [to statins] — some don’t want to be on meds.”
Prevention also plays an important role in lowering risk, Stone says. “In your 20s, lifestyle is important. Many people could avoid statins in the first place if they were to adopt a healthy lifestyle during their 20s and 30s, eat a heart-healthy diet and avoid weight gain,” he says. “Then they would not need them in the 40 to 60 age range.”
Even on a statin, it’s still important to maintain a healthy lifestyle. A statin does not give patients license to eat a high-fat, unhealthy diet or stop exercising, Stone adds.
Chicagoan Jamie Rachlin, 57, has seen the benefits of statins, but he knows that a healthy lifestyle is important, too. Rachlin started taking a statin eight years ago due to stubbornly high cholesterol that did not respond to his best efforts with diet and exercise. Immediately after taking the statin, he says, his cholesterol dropped from a dangerous high of over 250 to somewhere between 150 and 180.
But recently, he made a common mistake. “I assumed that [once you were on statins] you could eat anything you wanted,” he says. “This year I did that, and my cholesterol was back up. So it turns out I can’t eat as much cheese as I’d like, but being on statins, I feel like I can occasionally eat cheese, bacon, etc.”
Statins, like all drugs, can have side effects. Over the years, patients have reported muscle pain and foggy thinking. Statins can also occasionally cause a rise in blood sugar, leading to type 2 diabetes.
If the statin seems to be causing muscle pain, which is the most common complaint, Stone says he will usually take a patient off it for three weeks. If the pain disappears, he will try again with a lower dose or a different statin.
As for diabetes, Nijmeh explains, for most people the small risk of developing diabetes is outweighed by the benefits of preventing cardiovascular disease.
There could be unexpected benefits to statins, too. Some studies suggest that statins might diminish the risk of certain types of dementia by reducing or preventing blockage of arteries in the brain.
Chicagoan Cheryl Klehr, 62, saw her total cholesterol level drop 80 points within the first few months of starting a statin. She is on a low dose of Lipitor and plans to stay on it due to a family history of heart disease and high blood pressure and concern about the prevalence of heart disease among women.
“I am on these for life,” she says, “unless they tell me not to or suddenly discover something harmful about them.”
Statins can help enormously in guarding against the risk of cardiovascular disease and stroke. For those unlucky enough to be at elevated risk, statins can, quite literally, be a lifesaver.