Misleading claims and the proven facts on Cholesterols and Statins (from the ESC)

Some of the misleading claims, and the proven facts:

CLAIM: Cholesterol is not bad for us. It is a fundamental fat needed to make our cells. We can’t live without it.

FACT: Cholesterol per se is indeed essential for life. But LDL cholesterol in the blood produces fatty deposits called atherosclerotic plaques. These plaques restrict blood flow which can damage organs or lead to a heart attack or stroke. Nearly 3 million deaths worldwide are linked each year to high levels of LDL cholesterol.

CLAIM: Eating foods high in cholesterol (e.g. eggs or butter) does not kill you. Therefore, cholesterol is not a problem but a myth of the pharmaceutical industry designed to sell us drugs.
FACT: Eating eggs or butter in reasonable amounts does not increase cholesterol in the blood. An estimated 85 percent of cholesterol circulating in the body is produced by the liver, independent of what we eat, and that is where the focus should be. As for claims that the pharmaceutical industry is getting rich from selling statins, the vast majority of these drugs are no longer covered by patents. They are generics sold for cents.

CLAIM: There is no link between a population’s LDL-cholesterol levels and the frequency of heart attacks.

FACT: Globally, about 33% of coronary heart disease cases can be attributed to high cholesterol. More than half of Europeans (54%) have high LDL cholesterol. For adults between the ages of 35 and 55, even if they are otherwise healthy, every decade that they live with high cholesterol increases their chances of developing heart disease by 39%. Germany has one of the highest cholesterol levels in the world and is ranked second amongst high income countries in the rate of deaths caused by ischemic heart disease.

CLAIM: High LDL cholesterol is less dangerous than many other factors, including inactivity, smoking and obesity. Changing those things in our lives is where we need to act first. FACT: “All those factors are contributors to the risk of heart disease,” said Professor Stephan Gielen, past president of the European Association of Preventive Cardiology. “It is indeed critical to stop smoking, be physically active and watch one’s diet. But lifestyle changes typically reduce cholesterol levels by only 5 to 10 percent. For people with high levels of LDL cholesterol, more is needed,” he said. “Combining exercise and statin therapy substantially reduces the mortality risk and is potentially the ideal combination.”

CLAIM: The side effects of statins are not worth the risk.

FACT: The most common side effect reported by statin users is muscle aches (myalgia), which occurs in less than 1 percent of patients and are often alleviated by switching to another brand of statin. Claims of more severe side effects, including Type 2 diabetes, Alzheimer’s, and cancer have been occasionally reported, but the evidence is weak or misinterpreted. Statins can indeed raise blood sugars slightly. But one would have to have significant pre-diabetes to develop Type 2 diabetes because of a statin. This occurs in only about 1 percent of patients with pre-diabetes taking the medication.

On Alzheimer’s disease, a study recently published in the Journal of the American College of Cardiology found no association between statin use and a decline in memory or thinking ability. Indeed, patients who take statins for heart disease and have a genetic predisposition to Alzheimer’s disease actually scored better on some memory tests. The lead author of the study, Doctor Katherine Samaras, a professor of medicine at the University of New South Wales, Australia said, “If you are experiencing memory problems while taking statins, don’t stop. Talk to your doctor. You may have other factors for that memory loss.”

CLAIM: Those taking statins should simply stop taking them.

FACT: Published studies have shown that patients who are taking statins and at risk for cardiovascular disease, increase that risk if they stop taking the medicine. One alarming study of 28,000 patients found that 3 in 10 stopped taking their statins because they presumed the aches and pains they were experiencing were due to the drug. The result: 8.5% suffered a heart attack or stroke within just four years, compared to 7.6% who continued taking the drugs. And there is good evidence that the benefits of statin use continue well into old age.

CONCLUSION:

There is absolutely no question that the benefits of statins far outweigh any risk,”  “You owe it to yourself to see for yourself – to review the many published, peer-reviewed studies, from reputable institutions. The stakes are simply too high to do otherwise.”

 

https://www.escardio.org/Education/Practice-Tools/Talking-to-patients/arming-your-patients-with-the-facts-on-statins?twitter&fbclid=IwAR1CYhMPZKs2uGlf20N7MzycSZr88G_cUrQap4l8zh6STeaC1gEtsD3ln5U

 

 

We are much more than our cholesterol level.

 

The new guidelines on cholesterol treatment advocate aggressive control of Cholesterol levels by drugs called statins for primary prevention of heart disease. They advocate high-intensity and moderate intensity statins in patients with intermediate risks of developing heart disease.

Majority of the Physicians would be following these recommendations. But, there is a great need to discuss the risks and benefits of statin therapy with individual patients.

These become more relevant when we know that statins do increase marginally the incidence of developing diabetes.

Two recent studies also throw up interesting findings:

Study 1. A study presented in April 2014 at the Society of General Internal Medicine meeting in San Diego showed that individuals prescribed statin therapy for high cholesterol consumed more calories and more fat than nonstatin users. And, not surprisingly, this increase in calories paralleled an increase in BMI in statin users.

Study 2. An analysis of a prospective cohort study of men (published in JAMA Internal Medicine) revealed that physical-activity levels were “modestly” lower among statin users compared with nonusers independent of other cardiac medications and of medical history.

Though there may be a biologic or chemical explanation for the above findings, the above studies point to Lifestyle-Statin interaction whereby there seems to be a sense of protection felt by the patients on statins. Individuals on statins (due to a sense of security due to their drug compliance) may be abandoning on Diet moderation and Physical activity. This abandoning of important lifestyle measures would reduce gains of statin therapy.

The above findings suggest that Physicians need to continuously emphasise the importance of Lifestyle measures to individual patients irrespective of their cholesterol levels or statin therapy!

 

http://www.medscape.com/viewarticle/827675?nlid=60603_1985&src=wnl_edit_medn_card&spon=2#1

 

New Cholesterol Guidelines Abandon LDL Targets!

 

The American College of Cardiology (ACC) and American Heart Association (AHA), in conjunction with the National Heart, Lung, and Blood Institute (NHLBI), have developed and released Guidelines for Cholesterol Control after 9 years of the release of the last version. 

And they contain some substantial changes!

Gone are the recommended LDL- and non-HDL–cholesterol targets, specifically those that ask physicians to treat patients with cardiovascular disease to less than 100 mg/dL or the optional goal of less than 70 mg/dL.

According to the expert panel, there is simply no evidence from clinical trials to support treatment to a specific target. As a result, the new guidelines make no recommendations for specific LDL-cholesterol or non-HDL targets for the primary and secondary prevention of atherosclerotic cardiovascular disease.

Instead, the new guidelines identify four groups of  patients in whom physicians should focus their efforts to reduce cardiovascular disease events. And in these four patient groups, the new guidelines make recommendations regarding the appropriate “intensity” of statin therapy in order to achieve relative reductions in LDL cholesterol.

 

The Four Major Statin Groups

The four major patient groups who should be treated with statins were identified on the basis of randomized, controlled clinical trials showing that the benefit of treatment outweighed the risk of adverse events. The four treatment groups include:

1. Individuals with clinical atherosclerotic cardiovascular disease.

2. Individuals with LDL-cholesterol levels >190 mg/dL, such as those with familial hypercholesterolemia.

3. Individuals with diabetes aged 40 to 75 years old with LDL-cholesterol levels between 70 and 189 mg/dL and without evidence of atherosclerotic cardiovascular disease.

4. Individuals without evidence of cardiovascular disease or diabetes but who have LDL-cholesterol levels between 70 and 189 mg/dL and a 10-year risk of atherosclerotic cardiovascular disease >7.5%.

 

In those with atherosclerotic cardiovascular disease, high-intensity statin therapy—such as rosuvastatin (Crestor, AstraZeneca) 20 to 40 mg or atorvastatin 80 mg—should be used to achieve at least a 50% reduction in LDL cholesterol unless otherwise contraindicated or when statin-associated adverse events are present. In other settings a  moderate reduction of LDL-cholesterol may be aimed for.

The guidelines advise not to aim to achieve a target value of LDL-cholesterol in these patients subsets but advice to start statins in moderate or high intensity to achieve significant reductions in LDL cholesterol from their baseline levels.

 

via New Cholesterol Guidelines Abandon LDL Targets.

Who benefits from anti-cholesterol drugs (Statins): 2013 Guidelines by ACC.

Who benefits from anti-cholesterol drugs (Statins): 2013 Guidelines by ACC.

The new ACC/ American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults focuses on the use of statins for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in higher risk patients. Here are 5 key points you should know about the recommendations.

Drugs for Angina or cardiac pain!

Angina pectoris, which is more commonly known as angina, is severe chest pain caused by a lack of blood (ischemia) in the heart muscle.

The commonest cause of angina is blocks in the coronary arteries which cause obstruction to the blood flow.

The common drugs which are used to treat angina are as follow:

1. Beta-Blockers: This is a class of drug which reduces the heart rate. Thereby, they reduce the oxygen requirement of the heart. This causes relief in angina. 

The drugs approved for this condition are Metoprolol,  Bisoprolol, Atenolol, Nebivolol and Carvedilol. These drugs are started in normal doses and then increased till the time patient is free of his symptoms. Majority of the patients tolerate them well. They need to be monitored for the side effects like bronchospasm and slow heart rate. 

If a patient is unable to tolerate the beta-blockers, the alternative group of drug which can be prescribed is called Calcium channel blockers. Some of the drugs used are Diltiazem and Verapamil. They can be used in patients with lung problems as they have no effects on lung function unlike beta-blockers.

2. Aspirin: the commonest drug prescribed to all cardiac patients. This is an anti-platelet drug and thus prevents clot formation in the arteries. It is given in a dose of 75-150 mg a day. It should be consumed after food to avoid gastric irritation.

3. Statins: These are drugs which reduce cholesterol and triglyceride levels. The prevent the formation of plaques or blocks in the coronary arteries. They also reduce the incidence of heart attacks in the patients. The common ones used are Atrovastatin, Rosuvastatin, Simvastatin etc. They are to be taken after dinner for maximum effect.

4. Nitrates: There are drugs which cause dilatation of the coronary arteries and are very helpful in relieving angina. They can be taken by keeping the tablet below the tongue (Tab Sorbitrate) or consumed with glass of water. They are also available as oral sprays or skin patches. They can cause headache or giddiness as their side-effect.

Most of the patients with angina can be easily controlled with drugs and can be symptom-free (pain free). The non-medical options are angioplasty or bypass surgery which can be reserved for patients with intractable symptoms.

Long term Medications for patients with Heart attack!

Heart attack is the lay man’s term for a myocardial infarction. Myocardial infarction is nothing but damage to the heart due to blockage of the artery carrying blood to the heart.

So once the individual is stabilized, what are the medications he/she needs to take to improve his symptoms and reduce long term events (events like chest pain or a repeat heart attack)?

 

These are as follows:

 

1. Aspirin: This is blood thinner and prevents clot formation. The dosage recommended is 75 or 150 mg a day. It is preferable to take it after meals to avoid gastric irritation.

 

2. Statin: This is one of the most popular drug and know to reduce repeat heart attacks and long term mortality (death rates). These are anti-cholesterol medicines which reduce the bad fats thereby reducing blockages in the heart. The commonly used drugs here are Atorvastatin, Rosuvastatin and Simvastatin. The goal of therapy is to achieve a LDL-cholesterol value of less than 100 mg/dl.

 

3. Beta-blockers: These drugs reduce the heart rate and the blood pressure. This reduces the blood requirement of the heart and thus improves healing. It also reduces events like sudden cardiac arrest and angina pain. The commonly used drugs are Metoprolol, Bisoprolol, Atenolol and Carvedilol. 

 

4. ACE inhibitors: Again a group of drug know to reduce blood pressure and long term mortality. It should be given to patients with heart pumping less than 40%. It reduces the load on the heart and thus prevents further damage. The commonly used drugs here are Enalapril, Ramipril, Lisinopril etc.

 

All the above drugs should be take only after consultation with your doctor.

Also most of the time, the treatment is Long term! 

Most of the patients tend to discontinue their medications. This is not recommended as the benefits with the drugs are immense. So one should consult his Cardiologist and ensure that they are on the necessary medicines. In case of side-effects, there are good alternatives which should be discussed with the Cardiologist.

 

Take care!