February 1, 2014
Morrisville – As research accumulates on the benefits of lowering cholesterol to prevent and treat heart attacks and strokes, the American College of Cardiology and the American Heart Association periodically update their guidelines. The last full update was over 10 years ago, and quite a bit has changed since then. Luckily, the most common drugs for lowering cholesterol, called statins, have also gotten a lot cheaper since all but one are now generic. The four most common statins include atorvastatin/Lipitor, Simvistatin/Zocor, Pravastatin/Pravachol, Rosuvastatin/Crestor.
The new updates were released in mid November of 2013, and may change the way your doctor, nurse practitioner or physician’s assistant treats you.
If you have had a “clinical event,” which could be a cardiac stent, heart attack or a stroke, in most cases you will benefit from taking a ”statin” medication. These medications not only lower cholesterol, but importantly also reduce “inflammation” or the level of microscopic irritation in the blood vessels. For that reason, it does not matter in most cases whether you had high cholesterol or not. The medicine works almost regardless of your baseline cholesterol to reduce the chance of the next “clinical event” by one third to a half. Gone from the new guidelines are the old specific target numbers for cholesterol.
If you have diabetes, the story is quite similar. We know that people with diabetes have a higher chance than the general public of developing cholesterol blockages in arteries. If the artery is near the brain, that could lead to a stroke. If it is an artery supplying the heart, that could lead to a heart attack. If you are a person with diabetes between ages of 40 and 75, adding a statin slows or prevents blockages.
The new guidelines also ask your medical care provider to evaluate your “lifetime risk” of developing cholesterol blockages. If he or she decides that, based on factors such as smoking, family history, history of elevated blood pressure and, of course, your age, that you are prone to developing cholesterol blockages in your arteries, then it is often worth starting a statin preemptively to prevent cholesterol blockages in the first place. As the saying goes “an ounce of prevention is worth a pound of cure.” There is a new risk calculator with the guidelines, but doing the math and coming up with numbers is really just a place to start the discussion with your health care provider.
Not everyone wants to take a statin medication, and not everyone should . The risk of side effects is small, but should always be taken into consideration. Out of every 100 patients given a statin, 5 to 10 of them will have to stop taking the drug. The good news is that if you have a side effect from one statin, there is almost always another way to lower cholesterol that will work for you.
Don’t forget the tremendous benefits of healthy eating, regular exercise and plain old healthy relaxation. Don’t forget the tremendous benefits of healthy eating, regular exercise and plain old healthy relaxation. Yes, I said that twice on purpose!
The new cholesterol guidelines go to great lengths to emphasize the benefits of a healthy lifestyle. Particularly if you have inherited a tendency to develop cholesterol blockages, then a multi-pronged approach to prevention works best.
To conclude, I believe in the “ounce of prevention” saying. Take good care of your body, mind and soul. If your health care provider thinks you are one of those individuals who is susceptible to cholesterol blockages, then it is worth discussing if a statin medication, in addition to a healthy lifestyle, can help keep those arteries open.
Copley Hospital cardiologist Adam Kunin, MD treats a full range of heart conditions and diseases, including heart attacks, heart failure and serious heart rhythm disturbances, as well as providing pre- and post-cardiac catheterization care. Dr. Kunin works closely with you and your primary care physician in treating your cardiology needs. For more information about cardiology services at Copley visit www.copleyvt.org/medical-services/cardiology-heart-health/.