A 70 year old patient from the United Kingdom recently asked for a second opinion from another doctor after his own doctor unexpectedly prescribed statin drugs for him.
The second doctor looked at some of the patient’s vital health related statistics and recorded the following information :-
- Age 70
- Height 6 feet 1 inches
- weight 231 pounds
- cholesterol 4.6 mmol
What conclusions did he reach about the patient’s health ?
The second doctor agreed that the man was in good health, and had a low cholesterol reading, plus a good family health history too, with none of the primary risk factors for developing heart disease.
However he confirmed the prescription for statins issued by the first doctor due to the man being overweight.
Both doctors had calculated the man’s Body Mass Index (BMI) to be 30.5. An excessive BMI figure is generally accepted to be a fairly good indicator of potential future cardiovascular health problems linked to excess weight and body fat.
The normal reading for BMI in men is between 19 and 25, and a reading greater than 30 is classified as technically obsese. The 2nd doctor recommended that for his height, the man’s ideal weight should be 189 pounds, so he needed to lose 42 pounds !
Reason for taking statins when cholesterol level is not excessive
Most folks only associate statin drugs with one purpose – to reduce the level of bad cholesterol in the blood. However, new research published in November 2008, involving over 17,000 volunteers has shown that there are significant benefits to be obtained by taking statins by healthy people with normal cholesterol levels (under 5 mmol).
The study group was divided into 2 sub-groups – one half took a statin drug, whilst the other half were given a dummy pill (or placebo). The health of the entire group was planned to be tracked over the next four years, but the study was halted after 2 years as the results were so astonishing.
It was discovered that the group that had taken the statins suffered only half the rate of hospital admissions for heart attacks and strokes as the control group.
The study concluded that statin drugs not only regulate the amount of cholesterol in our bloodstream, but actually reduce the amount of inflammation present in the artery walls. This is a new discovery, and also raises a new question as to why arterial inflammation has more of a contributory factor to developing coronary heart disease than was previously understood.
One of the most fascinating aspects of this study was the discovery that the folks on the dummy pill exhibited similar side effects to the one’s who were taking the actual medication – which totally baffled the scientists.
So, our 70 year old patient was advised to continue to take the statin drug, but also to try and lose some weight, and take more exercise – good advice for most of the rest of us we feel.
What is cholesterol?
Cholesterol is an essential fat (known as a lipid) which is produced by the liver from the fatty foods we consume and is vital for health and normal body functioning. Although they are essential compounds, an excessively high level of lipids in your blood – a condition known as ‘hyperlipidemia’ can be disastrous to your long term heart health. Your risk of developing heart disease is increased, and it could lead to you suffering a heart attack or stroke.
What is High Cholesterol?
High cholesterol (Hypercholesterolemia) causes fatty deposits (known as plaques) to build up inside your blood vessels. Statistics show that approximately 2 in 3 adults possess cholesterol readings that are higher than the recommended level. High cholesterol causes these plaques to build up inside your blood vessels resulting in narrowing of the arteries, as you can see from the following graphic:
Symptoms of High Cholesterol?
A high cholesterol level may only become apparent if you develop symptoms of heart disease. Some people show physical symptoms such as yellowy patches (known as (xanthomas) which may develop around your eyes or elsewhere on your skin – these yellowy patches are ‘cholesterol deposits’ and indicate that you have higher than normal cholesterol levels in your blood as folllows:
Types of Cholesterol
There are three types of cholesterol – HDL (high-density lipoprotein), LDL (low-density lipoprotein), and VLDL (very low-density lipoprotein).
HDL (high-density lipoprotein
HDL is often referred to as ‘good cholesterol’, as it is thought to prevent arterial disease. This is because it takes cholesterol away from the cells and back to the liver, it is then either – broken down or is passed from the body as a waste product.
LDL (low-density lipoprotein
LDL is often referred to as bad cholesterol as it is known to increase arterial disease (build up of plaque in the arteries)) It carries cholesterol from the liver to the cells resulting in a harmful build up – thus causing the cells to have too much to break down – hence resulting in a build up of plaque.
VLDL (very low-density lipoprotein)
VLDL is also referred to as a ‘bad cholesterol’ as it contains the highest amount of ‘triglycerid’ (a blood fat); Triglycerides are found in dairy products, cooking oils, and red meat. Like LDL – VLDL cholesterol is considered as a type of bad cholesterol as elevated levels are also associated with coronary heart disease.
What are considered to be healthy cholesterol levels?
The ‘Joint British Societies’ which consists of a group of UK experts in cardiovascular disease recommend the following cholesterol limits for people who have coronary heart disease or who are at risk of developing it:
- Total cholesterol level – should be less than 4.0mmol/l
- LDL cholesterol level – should be less than 2.0mmol/l.
Whereas the United Kingdom National Institute for Health and Clinical Excellence (NICE) publish the following guidance for doctors:
- Total cholesterol level – less than 5.0mmol/l
- LDL cholesterol level – less than3.0mmol/l
However – the average cholesterol level in the UK is above normal, i.e. – 5.5mmol/l for men and 5.6mmol/l for women. Do these levels mean that you will go on to develop heart disease? Not entirely, as cholesterol levels need to be considered in accordance with an individual’s overall risk of heart disease. I.e. whether they have a genetic predisposition (one in 500 people has high cholesterol because of an inherited problem called familial hyperlipidaemia) smoke, have high blood pressure, are overweight, or have diabetes. Also, it is the balance of different types of lipoproteins that are present in the blood rather than the total cholesterol level that is really important.
How can I prevent having high cholesterol levels?
The first vital steps you can take in preventing a high cholesterol level or lowering it is to:
- Eat healthy
- Take regular exercise.
Healthy eating means cutting down on saturated and Trans fats. These should be re placed with unsaturated fats. There are also some foods that may help lower blood cholesterol levels such as – walnuts, oats, garlic, cinnamon, and soya. For more advice on healthy eating you can visit the British Heart Foundation website.
The American Heart Association has published details of a new statin drug – Crestor – which dramatically reduces the number of heart attacks and strokes, even for people without existing high levels of cholesterol in their blood.
The results of drug trials conducted in the United States, were so conclusive that they were prematurely halted in March 2008, just halfway through their planned 4 year term, as the medical profession considered that it would be unethical to continue giving placebos to half the trial patients.
It was discovered that a daily treatment of Crestor, also known as Rosuvastatin, dramatically cut the rate of heart problems and cardiac deaths by an amazing 44 per cent. Crucially, the U.S. study involved those who would not normally be considered at risk of heart problems.
Heart Attack and Stroke reduced dramatically
Heart attacks were cut by 54 per cent, strokes by 48 per cent and the need for angioplasty or heart bypass surgery by 46 per cent among the group on Crestor compared to those taking a placebo, or dummy pill.
Significantly, those taking Crestor, experienced a fifty per cent reduction in their levels of the ‘bad’ cholesterol known as LDL, and were 20 per cent less likely to die from any other cause.
The conclusion from the study, named Jupiter (Justification for the Use of statins in primary prevention), is that taking Statins could reduce the risk of heart attacks and strokes for everyone, even those with healthy cholesterol levels. However all the trial patients had high levels of a protein known as hsCRP – high sensitivity C-reactive, which is linked to inflammation of the arteries and heart disease. Now the U.S. researchers want this factor to be considered when deciding who will receive statins.
low cholesterol level is no longer safe
The lead researcher on the Jupiter study, Dr Paul Ridker, director of the Centre for Cardiovascular Disease Prevention at Brigham & Women’s Hospital in Boston, Massachusetts said: ‘Half of all heart attacks and strokes occur in men and women with normal cholesterol levels. We’ve been searching for ways to improve detection of risk in those patients. We can no longer assume that a patient with low cholesterol is a safe patient.’
Warnings against high regular statin dosage
However, experts have warned against trying to replicate the effects of Crestor – the newest and most effective statin – by using other statins at higher doses. Professor Martin Cowie, professor of cardiology at the National Heart and Lung Institute, Imperial College, London, said it was apparent that some statins worked differently from others. He added that ‘simply giving patients massive doses of other statins would not necessarily work and could increase the side effects to unacceptable levels’.
Professor Cowie pointed out that Doctors and Cardiologists are under increasing pressure to reduce the drugs bill by putting patients on the cheapest statins. He said: ‘I sympathise with the need to consider costs but you have to balance risks and benefits amid this push to switch patients to generic drugs, but high doses of statins can cause high rates of side effects like muscle pain and weakness’.
In the united Kingdom more than four million British patients regularly take statins to control their cholesterol levels. Eight out of ten use the cheapest generic drug, simvastatin, which costs just a few dollars per month. However, Crestor, which is made by AstraZeneca, costs approximately $40 per month for a 20mg daily dose.