Dr. Sudip Saha is a board-certified cardiologist with the Mid-Atlantic Permanente Medical Group. He sees patients at the Kaiser Permanente Tysons Corner Medical Center. He also cares for patients through video visits, phone calls, and secure messages.
Did your doctor recently tell you that you have high cholesterol? You are not alone. In fact, high cholesterol is one of the most common health problems in the United States. Approximately 92 million people take statins, making statins among the most often-prescribed medications to help treat high cholesterol.
Statins are overwhelmingly considered the gold standard in treating high cholesterol. They work by lowering the amount of cholesterol in your blood by reducing how much cholesterol your body makes.
Despite the popularity of statin medications, they do have some drawbacks. Yet, for most people, the benefits greatly outweigh the risks. Making the decision whether to start taking statin medications is one you should make after thoughtful conversation with your doctor.
During this American Heart Month, I encourage those who has been diagnosed with high cholesterol to talk with their doctor about ways improve their cardiovascular health, with or without medication.
What is Cholesterol?
Cholesterol is a type of lipid in your blood. If you have too much cholesterol, it starts to build up in the heart and brain arteries in the form of plaque. Blood may not easily flow throughout the body as the arteries narrow and harden — a condition known as atherosclerosis. This can lead to heart disease, heart attack, and stroke.
Total cholesterol of less than 200 is ideal for adults.
The total cholesterol number is made up of two parts: low-density lipoprotein (LDL) or “bad” cholesterol; and high-density lipoprotein (HDL) or “good” cholesterol.
LDL can cause blockages in the arteries; HDL helps remove bad cholesterol from them. Ideally, LDL should be less than 100 mg/dl. HDL should be between 40-60 mg/dl.
Cholesterol comes from what you eat and is produced by your liver.
What are Statins?
Statins are a type of medication that work by adjusting how your body handles cholesterol, essentially reducing the amount of cholesterol made by the liver. The liver creates different bile acids and other molecules that help us absorb cholesterol as well as help our bodies get rid of cholesterol. Statins help eliminate extra cholesterol from the bloodstream.
Statins have been well studied. We have decades of data showing they are safe and effective, reducing cholesterol numbers anywhere from 10 to 50 percent, depending on dosage and type of statin. Statins are one of our most tried-and-true medications in cardiology. As a board-certified cardiologist, I regularly prescribe them to my patients.
Who Should Take Statins?
Sometimes patients learn that their cholesterol is high and think they will definitely need to take a statin medication. But statins generally are not the first treatment option.
In general, patients with high cholesterol who are not considered to be at high risk of heart attack or stroke are counseled by their doctors to make dietary changes first. We recommend a Mediterranean diet, which emphasizes fatty fish, fruits, vegetables, beans, whole grains, nuts, and olive oil. A Mediterranean diet can lower cholesterol and thereby lower the risk of heart attack and stroke. But this doesn’t work for everybody: If cholesterol numbers don’t budge, doctors likely will prescribe a statin.
Statins also can be extremely beneficial for the following patients:
- Patients aged 40 and older with high cholesterol who have a high likelihood of having a heart attack or stroke in the future. Cardiologists have ways to calculate risk, based on cholesterol numbers, blood pressure, age, gender, smoking history, and whether the patient has diabetes.
- Patients with familial hypercholesterolemia. This is a genetic condition in which people have very high LDL cholesterol. This condition is usually diagnosed by pediatricians. Almost without exception, people with familial hypercholesterolemia should be on a statin medication.
- Patients who previously have had a heart attack or stroke. Statins can help prevent a future heart attack or stroke.
What Are the Names of Some Common Statins?
There are seven statins: atorvastatin (Lipitor); fluvastatin; lovastatin; pitavastatin; pravastatin; rosuvastatin (Crestor); and simvastatin (Zocor). They each work a little differently. A primary care physician or cardiologist can make a recommendation based on youyour healthstory, cholesterol numbers, and risk for cardiovascular disease.
What Are the Benefits of Statins?
From a primary prevention standpoint – meaning preventing heart attack or stroke in patients who haven’t previously had these problems – we know that statins can reduce your risk by 25 percent. And for people who have a prior history of heart attack or stroke, statins can reduce the risk of a future incident even more.
What Are the Risks of Statins?
Muscle aches and cramps are the most common side effects of statin medications. In rare instances, statins can cause liver damage. These problems usually go away when statin use is stopped.
I usually tell patients who have muscle aches shortly after starting statins to stop the medication for a few days to see if the aches go away, and then to restart the medication and see what happens. If the aches return, patients should talk to their doctor. There are different types of statin medications, so we can try a different one. For patients who cannot tolerate statins, we now have the option of bempedoic acid, which recent research has found to be effective in lowering cholesterol and lowering risk of heart attack and stroke.
There have been some claims that connect statin use with an increased risk of developing dementia, but there is no solid data to support that claim.
If I Start Taking Statins, Do I Need to Take Them Forever?
No! That said, if you stop taking statin medications, your cholesterol likely will go back up unless you make significant lifestyle changes focusing on a heart-healthy diet and exercise.
What Are Some Ways to Lower Cholesterol Without Medication?
In addition to eating a healthy diet and exercising, I encourage patients to quit smoking, limit alcohol, and manage stress.
Finding ways to manage cholesterol — with or without medication — is essential to preventing heart attacks and strokes. If your cholesterol numbers are high, reach out to your doctor to develop a treatment plan that is right for you.
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