Let’s take a moment to remember what cholesterol is all about, take a look at the traditional statin drugs, some newer medications on the market and talk a little about natural therapies that can provide valuable service to your cardiovascular health.
The big push over the last few decades has been to lower cholesterol to lower the risk cardiovascular events such as pulmonary emboli, myocardial infarction, and stroke. Sometimes we get so caught up in lowering one marker, we loose sight of the bigger picture. Cholesterol is only one component to cardiovascular health, however it is one that can be easily targeted with medication and tracked through blood analysis.
Cholesterol is a necessary component and building block for many of our hormones, Vitamin D and substances that help with digestion. We could not survive without it. The trouble comes when excessive cholesterol populates our blood stream, it is easily oxidized and creates deposits called plaques in our arteries.
Excessive cholesterol comes from our diet (cholesterol, trans fat, saturated fats or even if we consume too many carbohydrates) or from hereditary factors that affect cholesterol production. The plaques take up space and narrow the path that our blood flows through. When the plaque builds up enough it can block our blood supply, starving off the tissue it is designed to feed – this is an infarction.
The word infarction means “plug up or cram”. Sometimes a piece of the plaque can break off (emboli) and float through our blood stream and get caught in areas where the vessels are narrowed like our brain or lung and lead to a restriction of blood supply (another type of infarction). A myocardial infarction (MI) is when an area of the heart is starved of oxygen and the muscle tissue subsequently dies. A transient ischemic attack (TIA) is where there is temporary interruption of blood flow in the brain. A hemorrhage is where the integrity of the blood vessel wall fails and blood escapes.
Ok, so it makes sense to pay attention to excess cholesterol!
The Stats on Statins
HMG Co-A Reductase Inhibitors (i.e. atorvastatin/Lipitor, Fluvastatin/Lescol, lovastatin/Mevacor, pravastatin/Pravachol, simvastatin/Zocor, rosuvastatin/Crestor)
Cost at most $300/year CND
Generally: statins reduce LDL by 20-60%, increase HDL by 5-15% and reduce Triglycerides by 7-30% Statins are prescribed more to reduce cardiovascular event risk, rather than to reduce cholesterol levels.
Evidence of being able to treat to target levels doesn’t exist. Research has found that less than half of patients on 80mg per day will achieve at target LDL of <2mmol/L.
Most will find if they have no benefit at 10mg, they will not have any increased benefit at 80mg. Also, on the note of dosage, higher dosed statins affect HbA1c, a factor measuring your blood sugar and risk of type II diabetes. In a pooled analysis of data from 5 statin trials, intensive-dose statin therapy was associated with an increased risk of new-onset diabetes compared with moderate-dose statin therapy.
Women: For women, unless they have existing cardiovascular disease there is no evidence that lowering their lipids will decrease their risk of coronary heart disease related death.
Men: For primary prevention in men, the absolute benefit of statins use over 5 years (the reduction of major coronary events) is around 1.5%. That means if their risk of cardiovascular disease was 8 or 9% with no statins, while on statins, their risk is 7%. For secondary prevention in men (meaning they have already had one coronary event) their absolute benefit is 4%. This means if they have had a stroke, heart attack, heart failure, angina, TIA in the past, if they take the statin their risk is 16% where as if they didn’t it would be 20%.
Simvastatin is a first line of therapy. In one study, for every 12 people treated, one life was saved. Another study showed over 5.4 years of therapy for every 31 people treated, 1 death is prevented. Simvastatin will reduce LDL by 35% and usually the prescribed amount is 20-40mg daily.
Most common side effect: Often induces muscle pain (myopathy or at extreme rhabdomylosis).
About 50% of people will stop taking statins after 3 years due to their adverse effects.
Muscle pain aggravated by alcohol, advanced age (>80), chronic renal insufficiency, grapefruit juice, small body frame, liver health, untreated hypothyroidism, gender (women more affected than men), infections, perioperative periods, vigorous exercise, vitamin D deficiency. Drugs that will increase the muscle aches: Amiodarone, Azole antifungals, Calcium channel blockers, Cyclosporine, HIV protease inhibitors, Fibrates, Macrolide antibiotics (clarithromycin, erythromycin), and occasionally Nicotinic acid. If there is potential for drug interaction, the best choice is pravastatin.
What about the new drugs?
Alirocumab (Praluent ) about $14,600/yr USD
Evolocumab (Repatha ) about $14,100/yr USD
Benefit is there is no muscle pain however these are at a much higher cost and are self-injected every two to four weeks rather than taken orally. They work by blocking PCSK9 inhibitors, (monoclonal antibodies) and the medication is able to lower the LDL cholesterol circulating in the blood. Research is limited however so far it shows to lower LDL levels by about 60 percent. It also lowers the risk of heart attack and mortality related to heart disease over about a one to two-year follow-up.
What is available naturally?
Limit dietary cholesterol intake to <300mg per day
Restrict transfats and saturated fats
Limit carbohydrate intake
Eat more vegetables and fruit
Increase plant sterol intake to 1g 2x/day
Include up to 40g of fibre per day (most North Americans get <8g per day!)
Limit alcohol to 1 drink per day for women and 2 for men – have some days alcohol free
A Good Night Sleep
Supplements to help regulate blood glucose & incorporate healthy fats
There are numerous cardiovascular supplements you may wish to consider with your healthcare practitioner. Too many to mention here and they are specific to an individual’s overall need and one must be careful to have the right dose, duration and be sure there is no interaction with other medications or supplements.
One universal supplement that has been well studied is Fish Oil. Omega 3 and now new to the market Omega 7 has shown to be of benefit for many health factors. Omega 3 is well researched and there are over 20,000 published scientific reports that support its health benefits, including that are cardiovascular health. Fish oil has been shown to reduce serum triglyceride levels. A recent report on Omega 7 shows in a double blind placebo controlled study with 60 subjects and a baseline C Reactive Protein (inflammatory marker) at 2-5mg/L showed a 44% drop in CRP. You can look for Omega 3’s and will find them in most health food stores. On a side note, Metagenics has some serious research behind the Omega 7 and has combined the 3+7 in a formula rightfully called Mega 10. You can find Mega 10 at Forward Health.
From the heart and mind of your local naturopathic doctor, Dr. Laura M. Brown ND.
References available upon request.