Worried about your STATIN?

The FDA has updated the labelled recommendations on statins, the class of drugs most commonly used to lower cholesterol. Like many things medical, there was "good news & bad news". On the plus side, doctors are no longer obligated to check routine blood tests to see if the liver is behaving properly on the statin. We know that there is the potential for a rare, severe liver complication, but it turns out that the routine screening of the liver enzyme levels are ineffective in detecting or preventing it. On the negative side, the FDA now warns against the possibility that statins may raise blood sugar levels, because in several large trials there has been a marked increase in diabetes in patients taking statins (compared to those receiving placebo.) Additionally, the FDA has noted that statins might cause some "minor and reversible cognitive side effects". What does that mean? Basically, there is a subset of people who notice significant short-term memory loss or difficulty concentrating when they take statins. The good news is that those mental changes seem to revert back to normal (or at least, pre-statin levels) once you stop the drug. AND that this side effect occurs in less than 1% of patients.

What does this mean? Should we pull statins from the market? Why take a drug to help your heart when it hurts your liver, muscles, and brain, and could cause diabetes? Well, obviously we feel that in most cases, the benefits far outweigh the risks for this class of medication. Statins have been shown to decrease the risk of DEATH from cardiovascular disease by up to 25% in certain populations- this is a good thing! But- here's the rub-statins are not a substitute for a healthy diet and daily exercise, and not everyone with elevated cholesterol needs to take them. My own father used to chase down his cholesterol pill with chocolate and butter (though in fairness, he exercised every day of his life until his Parkinson's disease robbed him of balance and flexibility in his early 80's). But I digress...

How should we decide if a patient needs a statin? Number one, everyone initially diagnosed with high cholesterol should have dietary counseling on a high fiber, low cholesterol diet and see if they can improve their numbers through the behavioral modification of diet and exercise. Two, there is a wonderfully useful tool called the Framingham risk scorethat will help predict your risk of a cardiovascular event in the next ten years. Plug in your cholesterol, blood pressure & smoking status, and see if adding a statin will significantly lower your risk.

BOTTOM LINE: As with EVERY medication you take, be sure you understand the true anticipated benefits as well as possible risks of statins, and stay tuned...what we rave about today (in medicine), we shake our heads about next year.

Metabolic Syndrome- What's That?

Have you heard of "metabolic syndrome"? You should have, because almost one fourth of American adults- 47 million- have it! In fact, metabolic syndrome is passing smoking as the number one risk factor of heart disease in America. That's the BAD news. The GOOD news is that with lifestyle changes, you can reverse or at least delay onset of metabolic syndrome.

So, what is it? It is not your "metabolism", although it sounds like that. Metabolic syndrome occurs when you have three or more of the following:

A. Large waistline (>40” M; >35” F)
B. High triglycerides (similar to cholesterol)* (>150)
C. Low HDL* (the good cholesterol) (<40 men; <50 women)
D. HIgh Blood Pressure* (>130 top number or > 85 bottom)
E. High fasting blood sugar* (> 100)

The * means that if you are on medications for any of these conditions, it "counts", regardless of your current numbers.

What's the answer? Ultimately, weight loss is the answer. Start by moving MORE, and eating MORE vegetables and fruits.

BOTTOM LINE: If you have high cholesterol or are overweight, SEE YOUR DOCTOR and ask about metabolic syndrome, and what you specifically need to do to avoid or reverse it!

When Does High Cholesterol Start "Counting"?

Calcium and heart disease are staying together in the news. Yesterday, I talked about calcium supplements. Today, I want to tell you about another study- the "CARDIA" study (Coronary Artery Risk Development in Young Adults). Basically, this study looked at young people who began the trial at age 18-30 in the early 1980's. Their blood cholesterol levels were measured at baseline, and then followed periodically for twenty years. At the endpoint, coronary calcium scores were evaluated. (These scores are from a CT scan that looks at calcium deposits in the coronary arteries- the ones that if clogged, cause a heart attack.) The question was whether or not high lipid (cholesterol) levels in your youth led to these deposits in your middle age. The answer: a resounding YES.

As always, there is a catch. This time, the tricky part is that although high calcium deposit scores are definitely associated with heart disease, it is not the same objective evidence as whether or not people with early high cholesterol levels will actually have more heart attacks. I believe, however, that the take-home message is this: we do indeed pay for "the sins of our youth"- high cholesterol levels that are UNTREATED in young people are going to lead to problems down the road.

What should we do? The jury is still out on whether or not we should be starting younger patients on lipid-lowering medications, despite numerous studies trying to evaluate this issue. We DO know that improving diets and increasing aerobic activity reduces heart disease, with NO negative side effects.

BOTTOM LINE: Don't wait till you are 40 to check your cholesterol levels- find out EARLY and make lifestyle and dietary changes to improve your numbers NOW so you can decrease your heart disease risk LATER!