Heart Health

Heart Health:

Think Outside the Pill Box

By Dr. Todd Shaver

       We love quick and easy solutions: fast food, 15-minute oil changes, drive-through convenience stores, remote control everything.  Since February is National Heart Health Month, we should acknowledge that there are no quick and easy ways to achieve heart health.  The most effective way to keep your heart healthy (proper exercise, diet, and lifestyle) are simple and natural but require effort and discipline.  While statin drugs are widely used as the quick-fix method to prevent cardiovascular disease, they often involve significant risk and may not be as effective as commonly believed.

        Statins are cholesterol-lowering drugs.  Twenty-five percent of Americans aged 45 and older are prescribed these pills hoping for cardiovascular protection.   However, the European Heart Journal reported in 2015 that 4 years of statin drug use reduced heart-related hospitilizations, but not heart failure related deaths.

      In addition, the Expert Review of Clinical Pharmacology reported that statin drugs may actually increase the risk of heart failure and atherosclerosis (commonly called “hardening of the arteries”).  Statin drug use may increase cardiovascular risk by: preventing production of Vitamin K2, which is needed to help avoid atherosclerosis;  depletion of CoQ10, a vitamin-like substance critical to heart health; reduction of energy production in cells of the heart and blood vessels; interference with the protective anti-inflammatory activity of the nutrient selenium (problematic because inflammation promotes cardiovascular disease).

        Statins also have been shown to increase the risk of other diseases.  The Lancet, a medical journal in the UK reported in 2010 that one of every 255 people using statins over a 4-year period would develop diabetes.  With roughly 33 million Americans prescribed statins for long term use, that makes for a lot of statin-induced diabetes.

prescription bottle

        Experts writing in Current Opinion in Rheumatology estimate that 25% of statin users suffer from statin-related muscle problems (“statin myopathy”), which can include muscle pain, inflammation, weakness, fatigue, and cramping.  Statins can also cause rhabdomyolysis, a dangerous condition that destroys muscle tissue.

        The FDA has warned that cholesterol-lowering statin drugs may also cause cognitive impairment including “memory loss, forgetfulness, and confusion.”   In fact, The American Journal of Geriatric Psychiatry reports that elderly people with higher levels of cholesterol had the best memory function; low cholesterol is associated with increased risk for depression and death.

        Other “common reactions” associated with statins include headache, abdominal pain, nausea, dizziness, and constipation.  The FDA also warns that statins can cause liver disease. Other “serious reactions” include kidney failure and pancreatic disease.

        Many people believe that cholesterol is bad and that they should achieve the lowest possible score.  However, cholesterol is very important for overall health; it allows nerve impulses to travel smoothly from one cell to the next and is necessary for the production of progesterone, estrogen, cortisol and testosterone. It is also an antioxidant, and aids in digestion by the production of bile salts. Cholesterol is so important to brain health that 25% of the body’s cholesterol is in the brain. The how-low-can-you-go approach to cholesterol is not a healthy strategy.

        Statin use can lead to a false sense of security; this emphasizes the importance of considering options.  Since cardiovascular disease is an inflammatory condition, the key to prevention is an anti-inflammatory lifestyle.

       Evidence suggests that dietary modification is safer and can be more effective than statins.  For example, compare statin therapy with the anti-inflammatory Mediterranean diet. The “Number Needed to Treat” (NNT) refers to the number of people who must undergo a particular treatment to prevent a single adverse outcome.  A five-year regimen of statin drugs has an NNT of 104.2 for people who have never had a heart attack (i.e. 104 people must take statins for 5 years to prevent one extra person from having a heart attack).  The NNT is 83 for those using statins to prevent a second heart attack.  By contrast, the Mediterranean diet NNT is 61 for people without a history of heart disease and only 18 for those trying to prevent a second heart attack.

        In addition to diet, other lifestyle modifications promote cardiovascular health. Proper exercise, good sleep, meditation, chiropractic spinal adjustment, and supplementation with key nutrients & botanicals have been shown to have positive effects.  Our practice evaluates medical history, physical exam, and laboratory tests to develop programs employing these safe and natural interventions.  Patients following this guidance routinely achieve healthier cholesterol levels and laboratory evidence of reduced inflammation.

        Long-term statin therapy may be necessary for the minority of people whose cardiovascular risk results from uncontrollable factors such as heredity.  However, since most cardiovascular disease and high cholesterol is caused by lifestyle, the National Institutes of Health asserts that lifestyle modification should be the cornerstone of efforts to treat or reduce the risk of cardiovascular disease.  Furthermore, the natural approach helps control other risk factors that statin therapy does not, such as high blood pressure, overweight/obesity, and diabetes, as well as the tendency of the blood to form clots. You should not discontinue a statin drug without consulting your prescriber.  Instead, discuss with your prescriber what goals must be met to reduce or discontinue statin medication and then expand your healthcare team to include providers who will guide you toward meeting those goals.