The Cholesterol Conundrum
The Cholesterol Conundrum
Statin (cholesterol lowering) medications are the most prescribed drugs in the United States and popular around the world. So, how effective are they at preventing a heart attack? Studies show that 50% of all first heart attacks (also known as MI’s or myocardial infarctions) occur in people with normal cholesterol levels. So how do you know if statin medications will really work for you?
Statin medications lower “bad” cholesterol (LDL) effectively. This has been proven in study after study. However, if these medications are so effective, why do heart attacks continue to lead the all-cause mortality rate for both men and women? This is because the cause of heart attacks is multifactorial. There must be a “perfect storm” in order to create the conditions leading up the event.
Over time, excess cholesterol can be laid down in your coronary (heart) arteries if certain conditions occur. But the presence of plaques alone doesn’t mean you’ll have a heart attack.
Let’s discuss risk factors:
1. Family History/age/gender
2. LDL type and number
3. Insulin status (diabetes)
4. Elevated HS-CRP
5. High blood pressure (hypertension)
So what other factors play into your risk?
It’s not just the amount of “bad” LDL cholesterol, it’s the size and type of those LDL particles. Advanced blood cholesterol testing like an LPP or NMR panel can determine if you have small dense LDLs (thought to be higher risk) or large fluffy LDL (lower risk). And the sheer number of those particles also plays a roll.
And you can make a difference in those LDL particle sizes with statins. And with dietary changes like the Mediterranean diet. But you must do both. Over time, people taking statin medications often go back to their poor diets. And that can again increases risk.
If you have diabetes, especially type 2 (which is the most prevalent), high insulin levels can affect the LDL particle size. It’s another reason why good insulin control (lower levels) can decrease your risk for heart disease.
HS-CRP (high sensitivity C-reactive protein) is an inflammatory marker noted as a co-factor for increasing risk for heart attack. It can be easily tested and is covered by most insurance.
Free tools online
There are two very good tools, available free online that can help determine your long-term risk for heart disease. From the American Heart Association (AHA) follow this link: http://www.cvriskcalculator.com/. From the authors of the Framingham Heart Study website: https://www.mdcalc.com/framingham-coronary-heart-disease-risk-score.
Discuss with your physician
It’s very important to have a discussion with your clinician if you have any concerns about the medications you are taking. This isn’t a decision to be taken lightly, to start or stop any drug your clinician wants you to take. My purpose in discussing this topic is to bring in fully informed awareness to the decision-making process. Any decision you make is entirely up to you.