Without question, the best way to prevent cardiovascular disease (CVD) is to maintain a diet low in saturated fat (found in red meat and fatty dairy products) and high in fruits, vegetables, legumes and whole grains… and to do aerobic exercise (such as brisk walking) for at least 30 minutes most days of the week.
However: For women at high risk for CVD, even careful adherence to these guidelines is not enough — they need additional protection against heart attack and stroke. So do many women whose CVD risk is borderline (somewhat elevated) and who cannot or do not follow a healthful lifestyle. In such cases, doctors often recommend one of the statin medications, which decrease levels of low-density lipoprotein (LDL) “bad” cholesterol, artery-clogging plaque and inflammation.
Problem: Even though there is now strong evidence that statins protect women against CVD, millions of at-risk women still are not being offered the medication.
Statins can cause side effects, some potentially quite serious — so the advantages must be weighed against the disadvantages. What you need to know…
The Big News From a BIG STUDY
A recent study included 17,802 healthy women and men who did not have high LDL. What they did have were high blood levels of the compound C-reactive protein (CRP). This can be a sign of chronic inflammation, which contributes to heart disease. Some study participants took a placebo… others took rosuvastatin (Crestor) at 20 milligrams (mg) per day, a typical dose for a person with high cholesterol.
What happened: The study was halted after only 21 of its scheduled 60 months when a mid-study analysis showed that, compared with placebo users, statin users had 54% fewer heart attacks… 48% fewer strokes… and 20% fewer deaths. With those results, it became unethical not to offer a statin to the placebo group.
Consequence: In showing that statins prevent heart attack and stroke in women and men at borderline CVD risk, the study altered the balance of pros and cons that doctors use to decide whether to recommend a statin for a specific patient.
WHO’S AT BORDERLINE RISK?
The following are borderline risk factors — not worrisome enough to put you at high risk but still significant for assessing your odds of having a heart attack or stroke…
- Over age 65
- High CRP
- Blood pressure of 120/80 mm Hg to 130/85 mm Hg
- High stress levels
- Sedentary lifestyle.
New thinking: If you have two or more of the risk factors above, a statin may be appropriate. In making this determination, your doctor also may check for…
- High blood levels of apolipoprotein B (a particle in cholesterol)
- Coronary artery calcium score (an indicator of plaque) over 400.
WHO’S AT HIGH RISK?
Having either of the risk factors below puts you at high risk for heart attack and stroke…
- Confirmed heart disease — for example, you have angina (chest pain) or have had angioplasty (an artery-opening surgical procedure)
- Previous heart attack or stroke.
Also: You are at high risk if you have two or more of the following…
- Family history of heart attack (father before age 55, mother before age 65 or sibling at any age)
- Total cholesterol above 200 mg/dL
- LDL above 130 mg/dL
- High-density lipoprotein (HDL) “good” cholesterol below 50 mg/dL
- Triglycerides (a type of blood fat) above 150 mg/dL
- Blood pressure above 130/85 mm Hg
- Glycated hemoglobin, or HbA1c (a measure of long-term blood sugar levels), above 6%
- Type 2 diabetes
- Body mass index of 25 or higher
- Waist larger than 35 inches
- Current or recent smoking.
If you are at high risk, it is essential to talk to your doctor — a statin is almost certainly best for you.
CONCERNS ABOUT SAFETY
Statins’ side effects may include nausea, headache, muscle aches and memory loss. Rarely, statins cause serious damage to the liver, kidneys and/or muscles. Statins may not be appropriate if you have a problem with your liver, kidneys or thyroid or if you regularly have more than two servings of alcohol daily.
But: Don’t let fears of side effects deter you from trying a statin. If you do experience adverse effects, your doctor may suggest taking your statin at a lower daily dose or every other day… or trying a different statin.
Reduce side effects: Many statin side effects are caused by damage to mitochondria, the “engines” of cells. Because statins may deplete coenzyme Q10 (CoQ10) — a vitamin-like substance needed to produce energy in cells — CoQ10 supplements may help by strengthening mitochondria. A typical dose is 50 mg to 100 mg of CoQ10 daily, but some people need more — ask your doctor for guidelines.
ALTERNATIVES TO STATINS
One reason that doctors often recommend statins instead of supplements to reduce cholesterol is that far more research has been done on the drugs. Also, while certain supplements have been shown to lower LDL, no studies have shown that this translates directly to reductions in heart attacks and strokes.
However, some small studies show encouraging results from natural therapies.
Example: In a recent 74-person study, one group took a statin… the other group received diet and exercise counseling, plus daily supplements of fish oil containing almost 3,800 mg combined of the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), plus red yeast rice at 2,400 mg to 3,600 mg.
After three months: In the statin group, LDL dropped 40% and triglycerides dropped 9%…in the lifestyle/supplements group, LDL dropped 42% and triglycerides dropped 29%. How much of this improvement was due to lifestyle and how much was due to supplements is not known.
More research is needed before recommendations on red yeast rice can be made. However, there is so much evidence for the cardiovascular benefits of fish oil that virtually all women — whether or not they take a statin — should ensure that their intake is adequate. Best…
- If you are at low risk for CVD, have at least two weekly servings of cold-water fatty fish, such as salmon or mackerel… or take a daily dose of fish oil that provides 500 mg of combined EPA/DHA.
- If you are at borderline risk, eat fish four times weekly… or take 1,000 mg of EPA/DHA daily.
- If you are at high risk, eat fish four times weekly and take 2,000 mg to 4,000 mg of EPA/DHA daily.
Caution: If you take a blood thinner, such as warfarin (Coumadin), ask your doctor before taking fish oil.
Most people who take a statin continue for the rest of their lives. However, it is possible to reduce risk factors and negate the need for a statin through diet, exercise and other lifestyle changes. If there is a significant change in your health status or lifestyle — for instance, you lose a lot of weight or become a vegetarian — ask your doctor to reevaluate your need for the drug.
