Archive for October, 2009

Should you take a statin drug?

Posted on October 17, 2009. Filed under: 1 | Tags: , , , |

If your blood cholesterol level is too high or your LDL- (bad-guy) cholesterol is too high you should follow a health-promoting diet to lower it. As outlined in my Blog “Lower your cholesterol” you can lower your LDL-cholesterol by 20-40% by following a low-fat and low-cholesterol diet and using soluble fiber (oats or psyllium), soy protein, and plant sterols. It is safer to lower your LDL-cholesterol this way and by taking drugs. If you cannot get to the LDL-cholesterol levels recommended by your doctor you may need to take a statin drug. You should read my blog “How low should your cholesterol be” to decide how low you want your LDL-cholesterol value to be and whether you should take a statin or other type of drugs.

Statin drugs lower risk of heart attack by about 25%, especially for men who are less than 60 years old (1). However they have side effects. They may cause muscle aching in one out of  ten people (2) with serious damage to muscles occasionally (3)  as well as problems with muscle tendons  (4). They also can affect liver function and irritate the stomach. I have seen all of these side effects in my patients.  Not uncommonly they may cause neuropathy (nerve pain or tingling) (5), infrequently cause decreased cognition and very rarely they can cause serious neurological problems such as amyotrophic lateral sclerosis (Lou Gehrig’s disease)(6-8). Because they may accelerate loss of cognitive function as people age, I agree with some experts who recommend that people over age 70 should not take them unless there are extremely strong indications (progressive coronary heart disease)(1). Informed patients receive better health care and I think you should discuss your need with yours doctors (primary care doctor and cardiologist or specialist) before deciding to take a statin drug.

Statin drugs decrease levels of Co-enzyme Q10 in the blood and body tissues such as muscles and heart (1). This can cause muscle aching and impair heart pumping action. Taking a supplement of Co-enzyme Q10 may protect from these problems. I recommend that everyone who takes a statin drug take at least a 100 mg gel capsule of Co-enzyme Q10 twice daily. I have done research with the brand Q-Gel® and am convinced that it is the most effectively absorbed form of Co-enzyme Q10.                                                                                                                                                                            1.    Golomb BA. Implications of statin adverse effects in the elderly. Expert Opin Drug Saf 2005;4:389-97.

    2.    Joy TR, Hegele RA. Narrative review: statin-related myopathy. Ann Intern Med 2009;150:858-68.

    3.    Mohaupt MG, Karas RH, Babiychuk EB et al. Association between statin-associated myopathy and skeletal muscle damage. CMAJ 2009;181:E11-E18.

    4.    Marie I, Delafenetre H, Massy N, Thuillez C, Noblet C. Tendinous disorders attributed to statins: a study on ninety-six spontaneous reports in the period 1990-2005 and review of the literature. Arthritis Rheum 2008;59:367-72.

    5.    de Langen JJ, van Puijenbroek EP. HMG-CoA-reductase inhibitors and neuropathy: reports to the Netherlands Pharmacovigilance Centre. Neth J Med 2006;64:334-8.

    6.    Muldoon MF, Ryan CM, Sereika SM, Flory JD, Manuck SB. Randomized trial of the effects of simvastatin on cognitive functioning in hypercholesterolemic adults. Am J Med 2004;117:823-9.

    7.    Cramer C, Haan MN, Galea S, Langa KM, Kalbfleisch JD. Use of statins and incidence of dementia and cognitive impairment without dementia in a cohort study. Neurology 2008;71:344-50.

    8.    Edwards IR, Star K, Kiuru A. Statins, neuromuscular degenerative disease and an amyotrophic lateral sclerosis-like syndrome: an analysis of individual case safety reports from vigibase. Drug Saf 2007;30:515-25.

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How low should your cholesterol be?

Posted on October 17, 2009. Filed under: 1 | Tags: , , , , |

High blood cholesterol levels increase your risk for a heart attack or stroke. The best information is related to the low-density lipoprotein cholesterol level or the LDL-cholesterols (called the ‘bad guys) and cardiovascular risk. Many experts recommend that everyone should have a LDL-cholesterol value below 130 mg/dl (or a total cholesterol below 200 mg/dl). They recommend that the ideal LDL-cholesterol should be between 70 to 100 mg/dl for persons who do not have coronary heart disease (CHD). If you have CHD or have had a heart attack some experts recommend that your LDL-cholesterol should be below 70 mg/dl (total cholesterol below 140 mg/dl) (1;2). My research leads me to recommend that if you have CHD or have had a heart attack and are less than 70 years old your LDL-cholesterol should be between 60 and 80 mg/dl (total cholesterol of 130 to 150 mg/dl). Lower LDL-cholesterol levels may lead to more rapid loss of brain (cognitive) function as you get older (3). If you are over 70 years old, my research suggests that maintaining your LDL-cholesterol between 80-100 mg/dl (total cholesterol of approximately 150-170 mg/dl) is the prudent thing to do to sustain optimal brain (cognitive) function.
People with LDL-cholesterol values below 110 mg/dl (total cholesterol below 180 mg/dl) appear to have lower brain(cognitive) function than persons with LDL-cholesterol values above 110 mg/dl (3). The evidence that statin drugs decrease risk for heart attack for persons above the age of 70 years old is unclear (4). Some evidence indicates that statin drugs decrease brain (cognitive) function—perhaps by decreasing cholesterol available for to maintain the cholesterol levels required for the brain (4;5).
Reference List
1. Expert Panel. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). J Amer Med Assoc 2001;285:2486-97.
2. Keevil JG, Cullen MW, Gangnon R, McBride PE, Stein JH. Implications of cardiac risk and low-density lipoprotein cholesterol distributions in the United States for the diagnosis and treatment of dyslipidemia: data from National Health and Nutrition Examination Survey 1999 to 2002. Circulation 2007;115:1363-70.
3. Elias PK, Elias MF, D’Agostino RB, Sullivan LM, Wolf PA. Serum cholesterol and cognitive performance in the Framingham Heart Study. Psychosom Med 2005;67:24-30.
4. Golomb BA. Implications of statin adverse effects in the elderly. Expert Opin Drug Saf 2005;4:389-97.
5. Muldoon MF, Ryan CM, Sereika SM, Flory JD, Manuck SB. Randomized trial of the effects of simvastatin on cognitive functioning in hypercholesterolemic adults. Am J Med 2004;117:823-9.

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