If you watch TV, you've seen the ads for cholesterol medicines. You probably know their names – Lipitor, Zocor, Pravachol – even if you don't take them.
Some medical experts question the widespread use of these best-selling statin drugs except for high-risk heart patients.
A Business Week cover story in January suggested drug companies have oversold their benefits.
Revised cholesterol guidelines, which lowered targets for “bad” cholesterol, pushed more patients into the high-risk category and produced a bigger market for statin drugs.
But many doctors say despite the hype, statins are helping lots of people.
“People are sometimes dismissive of the benefits of medication and overly concerned about adverse effects,” said Dr. William Cromwell, with Presbyterian Hospital's Center for Preventive Cardiology. “The risks posed by these medicines are much less than the benefits of being on them.” In rare cases, statins can cause muscle weakness or achiness all over, said Dr. Bridget Bongaard, of NorthEast Internal and Integrative Medicine in Concord. Lowering the dose or changing to a different class of statin drug can help, she said.
The first step in cholesterol management is knowing your numbers.
Gone are the days when doctors focused almost entirely on total cholesterol and recommended a level of 200 or below.
Now, the focus is on components of cholesterol – LDL or “bad” cholesterol; HDL or “good” cholesterol; and triglycerides, or fatty acids in the blood. Recently, doctors have also begun paying attention to the number of LDL particles in the blood.
Even with low LDL cholesterol, a person can still have a high number of LDL particles, which puts him or her at high risk for heart disease, Cromwell said. (The particle test is recommended for patients already at high risk for heart disease.)
Family history of heart disease also puts patients at higher risk of heart disease themselves, no matter what their cholesterol levels. Diabetes and advanced kidney disease are also risk factors.
“Lifestyle changes are always recommended first,” said Dr. Cheryl Russo, a cardiologist with Sanger Clinic in Charlotte. “But it's challenging to make significant changes in your cholesterol with diet (and exercise) alone. A lot of cholesterol has a genetic influence. … If you're really far away from your goal, or you already have heart disease … we would definitely use medications.”
A healthy diet should be low in saturated fat and high in fresh fruits, vegetables and complex carbohydrates, such as whole grain breads and pasta. Omega 3 fatty acids, from fish or fish oil supplements, are also good at lowering cholesterol.
For exercise, the recommendation is 30 minutes of aerobic exercise, five days a week. A power walk could work.
“If you go on a Mediterranean diet, add a lot of nuts, eat a lot of vegetables, which have a lot of fiber, and you've got your olive oil, that's half of it right there,” Bongaard said.
Some patients can do their best to eat right and exercise, and they'll still need medicines, she said.
“If you come in with a cholesterol of 350, your chances of lowering that to below 200 are slim unless you're licking cardboard.”