Do more than lowering LDL to prevent heart disease...

Today's post: Tuesday, 1-29-2008

The main reason that doctors prescribe statins is to lower LDL to help prevent what the doctors call clinical events – called heart attacks, angina, & strokes by lay people.

There is evidence that if your LDL is over about 120, & definitely over about 160, it’s probably protective to lower it to below 120 or even well below 100.

I subscribe to an online newsletter for doctors & other health professionals called Medscape which had a quote I thought well worth doing a post about.

1. I think it overstates what statins do to some degree.

2. It clearly shows that a doctor who is quite knowledgeable about preventing heart disease believes that you need also to control several other factors to prevent heart disease & lists some of the important ones besides LDL cholesterol.

3. It begins to show how you can get better than statin heart attack protection without having to use statins in many cases.

Here’s the quote which Medscape itself took from a publication called “heartwire”

"The message for me is not that lowering LDL cholesterol doesn't work to prevent disease progression or to prevent clinical events," Dr Steven Nissen (Cleveland Clinic, OH) told heartwire.

"The important thing to remember is how the cholesterol levels are lowered. Statins do a lot more than reduce LDL cholesterol. They also increase HDL cholesterol, decrease triglycerides, and decrease C-reactive protein levels. ….”

1. Statins DO reduce LDL cholesterol; & I’ve read that they also lower inflammation, for which testing C-reactive protein levels is one marker that has been shown to be predictive of heart risk when it’s high.

However, niacin increases HDL cholesterol & lowers LDL cholesterol well. There may be some statins that increase HDL cholesterol; but I’ve not read that any of them do that as well as niacin.

And, I’ve seen no reports that statins lower triglycerides. (There may be such reports but the before & after taking a statin blood tests of someone I know who had both high LDL & high triglycerides showed her LDL reduced nicely & virtually no change in her sky high triglyceride levels.)

Once someone can do it safely, regular & vigorous exercise does boost HDL, lower triglycerides, & do the related lowering of the amount of the dangerous smaller sized LDL that literally sludges up your blood vessels & causes heart & cardiovascular disease. (The larger, “fluffier” LDL particles tend to bounce off & not cause these problems.)

3. In addition, there are sterol supplements & foods high in soluble fiber like beans that have other health benefits that will lower LDL levels nearly as well as statin drugs. This works especially well if you also stop ingesting transfats & reduce the amount of animal based saturated fat you eat. (This means less butter, full fat dairy products, & fatty meats.)

There are supplements that lower homocysteine. Homocysteine when it’s too high acts as a catalyst to increase or cause cardiovascular disease. This blood marker, I’ve read, is more predictive of heart disease than high LDL cholesterol. And, statins don’t lower it as far as I’ve read.

Also, in addition to niacin, eating the right foods -- & stopping the bad foods like transfats, taking the sterols & the supplements that normalize high homocysteine, you can eat fruits & vegetables that are high in antioxidants & take antioxidant supplements.

This also helps prevent heart disease also since oxidized LDL is a cause of heart disease while un-oxidized LDL apparently is not.

These other measures taken together will provide better protection than statins for most people from what I’ve read. And, they do this with added health benefits instead of the potentially health damaging side effects that come with statin use.

The advantage statins have is that they are known by doctors to work to lower LDL levels over 160 & those far over 160.

So, for doctors who do not know these alternative methods & for patients who will only take ONE pill & won’t exercise or eat right or who have very high levels of other risk factors that suggest FAST protection is needed, doctors will prescribe statins.

But if you are willing to make an effort on your own behalf, there are some things you can do that will give you much better heart attack protection than taking statins alone.

Dr Steven Nissen is totally right that optimizing all of the key markers for heart attack protection gives MUCH better protection than just lowering the total level of LDL cholesterol.

So, it looks to me that the two best options are:

a) take statins & do all the other things that statins do not do or do not do well to prevent heart disease.

b) do the other things that effectively lower your LDL cholesterol & do all the other things that statins do not do or do not well to prevent heart disease.