Wednesday, October 6, 2010

To Statin, or Not to Statin- That is the Question!

Okay, in this day and age of fixing everything with pills, we are often faced with whether or not to start a patient on a cholesterol lowering drug (a statin.) How can we decide if the benefits outweigh the risks? How much improvement can we expect from a medication?

Often, simply educating the patient about a high fiber diet will do the trick, especially if it is his or her triglycerides (the smallest breakdown product of fat) that are really high. Eating a diet with more than 25g of fiber per day will often lower lipid levels to our goal range. How do we do that? At the risk of beating a dead horse, it's MORE fruits and vegetables, plus some extra sources of high fiber such as beans, nuts, more berries, or high fiber cereals such as Fiber One or Bran Buds.

What is HIGH? Total cholesterol >200, triglycerides > 150, LDL (bad cholesterol) > 130 [or >100 if other heart risk factors such as diabetes, high blood pressure or smoking], or LOW HDL (the good cholesterol that takes away plaques) which is <40 in men and <50 in women. If you have more than one number above normal, it's time to consider either serious dietary modification or perhaps medications.

Luckily, we have a tool that can help us decide whether or not to start medications. The Framingham Risk Score looks at your lipid levels and calculates your risk of an adverse cardiac event in the next decade. You can plug in "improved" numbers (that you would get with a drug like Lipitor, Zocor, or Crestor) and see how much, if any , it lowers your risk.

BOTTOM LINE: If you are deciding whether or not to start (or continue) a statin medication, consult with your doctor and discuss your Framingham risk score!

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