A month to change your heart: Day 11

Under the new guidelines, which were issued in 2014, once someone qualifies for statin therapy, the dose should be determined by the person's risk of cardiovascular disease and not according to how cholesterol levels respond to treatment.

One goal of this month of change is to understand when prescription medications are needed, and when you may have alternatives.

If you already have a heart problem such as having undergone bypass surgery, you will almost always need cholesterol medication, usually a statin. You should know that there is overwhelming scientific evidence that statins can help reduce your risk of having another heart attack or bypass.   Statins also have been shown to help those with a history of a stent, a stroke, heart attack, diabetes, or those with super high LDL cholesterol, over 200 mg/dl.

For those who really need them, statins can be lifesaving.  Yet, many people stop them at the first sign of muscle aching, or because someone they know had a problem with statins, and often do not tell their doctors they’re no longer taking their medication. 

We hope that offering more information will help solve that problem.

If you are not sure if you need a statin, and have never had a heart problem, ask your doctor about  a calcium scoring CT scan, which can help figure out the need for statins in borderline cases.

Let’s look into the statins a little more closely:

  1. How they work:  Most cholesterol is made in our livers.  Statins stop an enzyme that is responsible for producing cholesterol.  This enzyme, for an unknown reason, is most active around 4 a.m., which is why many statins are best taken at bedtime.
  2. Effectiveness:  Statins lower cholesterol by as much as 35-50% at higher doses.  Every time the dose is doubled, your cholesterol will decrease approximately another 7%.  Interestingly, sustained lifestyle changes can often lower cholesterol as much as 10%,
  3. Stopping them:  Although some of the longer acting statins such as Lipitor and Crestor can be taken every other day, if you stop your statin, your cholesterol will start to go up in 2 or 3 days, and be just as high as it ever was in just a couple of weeks. 
  4. Side-effects:  Muscle aching may occur in 5 to 20% of people who take statins.  It is sometimes hard to know if your aching is from getting older, exercising, or from the medication, and there is no test to answer that question.  Actual muscle damage is rare, but can happen.  Other side effects from statins that are rare include foggy thinking, liver problems, and GI upset.  These will all usually go away quickly when the medication is stopped.  Grapefruit juice can slightly increase the chance of muscle side-effects, so don’t drink it with your medication.
  5. Generics vs Trade Name:  Generic statins are much cheaper, and I almost always recommend them, unless you have had side-effects from a generic.  It is possible to get a 3 month supply for as little as $10.

There are other prescription medications that lower your cholesterol.  Here they are ranked according to my opinion of how effective they are:

  1. Repatha and Praluent.  These two newcomers are called PCSK 9 inhibitor drugs.  They need to be injected by a syringe into your skin every 2 weeks to a month.  So far, they seem to be very effective in lowering cholesterol, but insurers don’t cover them, as we do not yet know if they lower the risk of heart attack, and they cost as much as $28,000 per year.
  2. Resins.  These medications, by the name of Welchol, Questran, and Colestid, all work by binding with the bile acids in your intestines.  They can cause cramping, and must not be taken with other  medications, as they can gobble up other drugs along with the bile acids.
  3. Zetia.  This drug is not a statin, and works mainly in your stomach to help prevent your intestine from absorbing cholesterol.  It will lower cholesterol about 10% on its own, and a bit more when combined with a statin
  4. Niaspan.  This is a prescription brand of niacin. Recent information suggests little effect of niacin when added to a statin.  It may help lower cholesterol if you are not on a statin.

There are some good non -prescription methods that can lower your cholesterol.  We will get into to them next week in a discussion about supplements

On the eleventh day of Change of Heart, my doctor said to me:

  1. Statins have been shown to both lower cholesterol, and decrease the risk of heart attacks in those with a history of heart issues.
  2. Always talk to your doctor before stopping your cholesterol medication
  3. Side-effects include muscle aching in a minority of patients, but there is not a good test available to know if the drug is at fault.
  4. Generic statins are safe, and can save you a lot of money.
  5. New medications called PCSK 9 inhibitor injections appear promising, but are very expensive

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