Hopping on the Statin Train

By: Red Hot Mamas

Published: May 26, 2010

The fact of the heart health matter is – nearly twice as many women in the US die of heart disease and stroke as from all forms of cancer, including breast cancer. The higher a woman’s blood cholesterol level, the greater her chances are of developing heart disease. The good news is you can control your cholesterol and lessen your chances for heart attack and heart disease. Even if you already have heart disease, it is possible to lower your cholesterol and maintain healthy levels.

Whether you choose to maintain a healthy heart through lifestyle modifications, or by taking a pill, is a decision up to you and your clinician. Although, these days taking a pill (specifically a class of drug called statins) may benefit more than just your cholesterol. The long list of health benefits from statins continues to grow as more, large, new studies are released.

A long list on the benefits of statins already include reducing the risk of dying from pneumonia, reducing the development of blood clots in the legs and even protecting against Alzheimer’s disease. These little pills sound like the cure-all capsules for longevity but are they for everyone?

Just last month, research presented at the American Heart Association convention (also published in The New England Journal of Medicine) found statins significantly reduce the risk of death from heart attacks and strokes. The study, called Jupiter, included 18,000 participants comprised of women, blacks and Hispanics without any history of high cholesterol or heart disease. However, all participants had elevated levels of a particular protein called high-sensitivity C-reactive protein (CRP) that can cause inflammation in the artery walls. The trial was stopped midcourse by the monitoring board because the benefits of statins were so striking: those persons taking the statins had 54% fewer heart attacks, 48 percent fewer strokes and 20 percent fewer deaths from all causes.

Now, scientists raise the question: should more people be screened for CRP levels or should they just go ahead and take statins since even people with low levels of cholesterol can benefit from the drugs?

According to Phyllis Greenberger, M.S.W., president and CEO of the Society for Women’s Health Research, “Half of heart attacks strike those with normal cholesterol levels.” Jupiter suggests the use of statins among the healthy, with a low risk of heart disease and low-cholesterol may be worthwhile. “All of this suggests,” Greenberger continues, “that women should learn more about preventing heart disease."

Since, half of all heart attacks and strokes occur in people whose cholesterol levels are not high, it is important for you to discuss with your clinician whether taking a statin could be of benefit to you.

Let’s step back a minute and talk about what cholesterol exactly is and why it is so important. Women between the ages of 45 and 55 are disappearing into the “cholesterol gap” between men and women. Currently, women’s cholesterol levels begin to rise higher than men’s and their risk of heart disease also increases. In order to understand this, you must understand the difference between good cholesterol and bad cholesterol.

You take the good, you take the bad

You take the good, you take the bad and there you have “total cholesterol."  Cholesterol is a fat (also known as a lipid) that helps the body stay well-oiled and running.  When your body has too much cholesterol, it gets deposited on the inside of your blood vessels.  This buildup can make the arteries narrower and narrower and less blood is allowed to flow to the heart.  If the vessels become totally obstructed, blood and oxygen cannot reach the heart and the result is a heart attack.

Lipoproteins are the little packages that carry cholesterol through the bloodstream.  There are two kinds of lipoproteins—the good ones (high density lipoprotein or HDL) and the bad ones (low density lipoprotein or LDL).  The good guys help prevent the buildup of plaque by carrying extra bad cholesterol back to the liver to flush it from your body.  Too much of the bad guys (LDL) can lead to cholesterol buildup and block the arteries.  Your goal should be to lower your LDL as much as possible because the higher the levels, the greater your risk is of developing heart disease. Dietary fat and its resulting cholesterol have been linked to heart disease and colon and breast cancer in women.

Cholesterol profiles

Cholesterol profiles measure both HDL and LDL levels.  So, you can monitor them to determine if they are at healthy levels.  We recommend every women age 20 and older have a “lipoprotein profile.”  Here are some levels to think about:

Blood Cholesterol Levels and Risk of Heart Disease

Another important aspect of your total cholesterol is your level of triglycerides.  This is another type of fat that your body uses to store energy.  They are usually found in small levels in your body, but can be produced more rapidly when you drink alcohol or take in excess calories.

You should aim to keep triglyceride levels below 150 mg/dL by limiting your intake of carbohydrates, cholesterol and saturated fats.  Also, more physical activity, avoiding smoking and alcohol can also help.  Sometimes, medication is needed.

Is my cholesterol putting me at risk for heart disease?

The following risk factors may increase your LDL and the risk of heart disease:

  • Smoking
  • High blood pressure (140/90 mmHg or higher, or if you are on blood pressure medication)
  • Low HDL cholesterol (less than 40 mg/dL)
  • Family history of heart disease (your father or brother before age 55, or your mother or sister before age 65)
  • Age (55 or older)
  • Metabolic problems (overweight/obesity)
  • Triglycerides of 150 or more
  • Blood sugar of 100 or more

Lowering your bad cholesterol

You can control your cholesterol through lifestyle modifications, medications or a combination of both.  “TLC” or “Therapeutic Lifestyle Changes” is an important treatment program for women.  There are three components to TLC:

  1. A cholesterol-lowering diet – lower calories and fats in your diet to avoid increasing your risk of heart disease.  Also, cut back on the sugars.
  2. Regular physical activity – physical inactivity raises your risk of heart disease and increases risk factors including blood pressure, diabetes, osteoporosis, etc.
  3. Weight management – if you are overweight, you are more likely to develop heart disease even if you have no other risk factors.  Being overweight also increases other risk factors including diabetes, high blood pressure and high blood cholesterol.

If your “TLC” doesn’t work to lower your cholesterol, then you might want to think about medications.

Commonly prescribed cholesterol-lowering medications

  • Statins – This can lower LDL cholesterol by 20 to 60 percent.  
  • Bile Acid Sequestrates – LDL cholesterol can be reduced by about 10 to 20 percent.  This medication is usually prescribed to work along with statins.
  • Nicotinic Acid (also called niacin) – lowers total cholesterol (including LDL and triglyceride levels) but raises HDL levels.
  • Fibrates – Can reduce triglyceride levels by 20 to 50 percent while increasing HDL by 10 to 15 percent but usually not very effective for lowering LDL levels.
  • Ezetimibe – A new class of cholesterol-lowering drug that interferes with the absorption of cholesterol in the intestine.

Over 18 million Americans are currently fighting their cholesterol with statins, but are they being over-prescribed? Doesn’t everyone want to prevent heart disease? Yes, but they could be giving a false sense of security in a way. People may forget about the other important risk factors like high blood pressure, lack of exercise and poor diet, not to mention the many side effects that may accompany the drug.

Common side effects of statins include nausea, diarrhea, constipation, muscle aches and some have been found to block the body’s production of an important antioxidant called coenzyme Q10 (CoQ10) which is essential for the production of energy in organs and tissues. Some doctors prescribe supplements to boost CoQ10 levels.

It is up to you and your clinician to determine if you are a candidate for statins. Before you jump on the statin train, take a look at your lifestyle habits. Are you exercising enough? Are you eating properly? Are you smoking? Changing these habits may just be enough to counter-balance your risk profile and avoid taking statins all together. Have a heart. Protect your ticker. Make healthy heart decisions. If you try all these interventions and they still aren’t enough, you may need the help of a prescription medication.

Learn why your risk of developing cardiovascular disease (CVD) increases at menopause: Potecting Your Ticker

References

Belluck, Pam. "Cholesterol-Fighting Drugs Show Wider Benefit." New York Times Health. 09 November 2008. 19 Nov 2008

Dunham, Will. "Statins May Cut Pneumonia, Death, Blood Clot Risks." Reuters Health. 28 October 2008. 19 Nov 2008

Kotz, Deborah. "The Smart Take on Statins." US News & World Report. 06 February 2008. 19 Nov 2008

Parker-Pope, Tara. "A Call for Caution in the Rush to Statins." The New York Times Health. 17 November 2008. 19 Nov 2008

Ridker, Paul M, Danielson, Eleanor, Fonseca, Francisco A.H., Genest, Jacques, Gotto, Antonio M., Jr., Kastelein, et. al., "Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein" N Engl J Med 2008 0: NEJMoa0807646

"The Truth About Statins." CBS News. 17 January 2008. 19 Nov 2008

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