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Healthy You Archives |
Protecting Your Health
Should You Be on a Cholesterol-Lowering Drug?Statin medications offer strong benefits, few risksIf your doctor has recommended a statin drug to lower your cholesterol, it’s not surprising. The guidelines for LDL (“bad”) cholesterol are going lower, and research shows statins do a bangup job of lowering LDL.“I’ve become more aggressive about encouraging my patients to consider statins,” says internist James Freeman, D.O., of Lehigh Valley Hospital and Health Network—and he’s typical of many doctors today. The pluses and minuses of statinsStatin drugs (such as Pravachol, Lipitor and Zocor) reduce heart disease risk in two ways, says Lehigh Valley Hospital and Health Network cardiologist Martin Matsumura, M.D. “Long-term, they lower the artery-clogging aspects of cholesterol. More immediately, they reverse factors in the artery wall that cause heart attacks.” Statins also may be useful for stroke, osteoporosis, Alzheimer’s disease and multiple sclerosis.Is there a downside to these wonder drugs? All drugs have some side effects, Freeman says. Statins can cause muscle aches, and you shouldn’t take them if you have liver disease. “But generally,” he says, “they cause mild side effects, if any.” Statins can have a noticeable effect on your budget. The cost can run to $120 a month or more, but your doctor may be able to substitute a statin for other medications you’re on that may be less beneficial. Other cholesterol-lowering optionsIf you’re an anti-pill sort of person, can you effectively lower LDL with diet or exercise? “Not with exercise alone, though fitness is very important to overall health,” says cardiologist Gerald Pytlewski, D.O., co-medical director of the Dr. Dean Ornish Program, Lehigh Valley Hospital and Health Network.Exercise combined with the typical low-fat diet—about one-third of total calories from fat—can reduce cholesterol up to 10 percent, he says. To achieve the 30-40 percent reduction statins can produce, you’d need a minimal-fat diet like Ornish. Fish oils (or omega 3 fatty acids) lower LDL to some degree and have other heart-protecting effects, Pytlewski says, and red rice yeast helps prevent cholesterol absorption. Niacin can be an effective alternative to statins in lowering LDL, but to get the benefits you need about 2 grams a day—an amount that can cause uncomfortable flushing in many people. The benefit of all these substances depends on your specific cholesterol profile and heart health, Matsumura says, so talk to your doctor before trying them. (That goes double for the “natural” supplements you hear about on the Internet.) “It’s unlikely any other product will do as good a job as quickly as a statin,” he says. Deciding if statins are for youStill reluctant to try a statin? When a patient of his feels this way, Freeman will agree to a diet-and-exercise approach “if their cholesterol is only borderline high and there are no other significant heart disease riskfactors.” If the person does have risk factors (high blood pressure, diabetes, obesity, smoking, or a personal or family history of heart disease), Freeman suggests combining lifestyle changes with medication. “I tell them that if they achieve good results in three to six months, we can consider lowering the dose,” he says. Clearly, cholesterol-lowering is a highly individual matter. But it appears that statins are a good answer for the vast majority of people with high LDL, regardless of gender or age. “I always weigh the risk/benefit ratio of a new medication,” Matsumura says. “The more we learn, the more heavily the benefits of statins outweigh the risks.” As Freeman puts it, “the studies keep making these drugs look better and better.”
Want to Know More about the latest thinking on cholesterol levels? Call 610-402-CARE. This page last updated 2/12/08 04:08 PM
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