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Without cholesterol, we couldn't live. Our bodies create it to form cell membranes, several hormones and fat-dissolving bile acids, among other things. However, most of us have too much cholesterol in our blood - often from fatty foods we eat. It clogs our arteries and puts us at risk for America's number one killer - coronary heart disease.
Reducing saturated fat and cholesterol in your diet, shedding excess weight, and exercising can help you lower your cholesterol. These lifestyle changes are the first line of defense in fighting high cholesterol. Yet, increasingly, physicians are reaching for the prescription pad and prescribing powerful drugs known as statins to help control their patients' cholesterol. What gives?
"Lifestyle changes are very difficult for most of us," says Peter Jones, M.D., a professor of medicine who specializes in preventive cardiology at Baylor College of Medicine in Houston. "We use a lot more drugs because people won't do the right things."
Jones notes, too, that some people have a genetic predisposition to high cholesterol. For them, he says lifestyle changes don't make much of a difference.
A powerful weapon against heart disease
The American Heart Association estimates that nearly half of all Americans have total blood cholesterol values of 200 mg/dL and higher, and about 40.6 million American adults have levels of 240 or higher. In adults, total cholesterol levels of 240 mg/dL or higher are considered high risk for heart disease, and levels from 200 to 239 mg/dL are considered borderline-high risk.
Statins, which have been on the market for about 16 years, have become one of the most powerful weapons against heart disease. Studies have shown that statins can cut the risk of cardiovascular disease by at least 30 percent. Studies have also demonstrated that patients with normal cholesterol levels could benefit from statins, even if they have no evidence of heart disease.
As a result, statins, which were once reserved for people with dangerously high cholesterol, now are being recommended for healthy patients who have marginally high cholesterol levels.
While no one yet has suggested that statins be put in drinking water, two of the drug companies that manufacture statins think you should be able to buy them over the counter. Merck & Co., maker of Mevacor®, or lovastatin, and Bristol-Myers Squibb, maker of Pravachol®, or pravastatin, have applied to the Food and Drug Administration (FDA) to sell their drugs over the counter. So far, the FDA has opposed switching any prescription cholesterol-lowering drug to over-the-counter status.
Statins are not for everyone
The recent voluntary withdrawal of one of the statin drugs, Baycol® (cerivastatin), by its maker, Bayer Pharmaceutical, also serves as a cautionary tale that statins, like a lot of other powerful drugs, pose certain health risks and should not be used by everyone.
Baycol was withdrawn because 31 patients using it died. The deaths were attributed to an unusual condition called rhabdomyolysis (rhab-doe-my-olysis), in which muscle tissue breaks down. The condition, which can occur taking any statin, is rare. It can, however, lead to kidney failure and can be fatal.
Most of the patients who died using Baycol were taking high doses of the drug, and 12 also were taking the drug in combination with gemfibrozil, a nonstatin drug that lowers triglycerides.
"Statins have many more benefits than risks. People should not be afraid to use these drugs," Jones says. "They just need to be aware of the special issues that increase their risk of getting a muscle problem."
Should you take a statin?
When a physician considers putting a patient on a statin, different factors are weighed, including a person's overall health, cholesterol level and risk factors for heart disease or a heart attack.
"Not everyone should get it. It depends on what else is going on with their life," advises James Cleeman, M.D., coordinator of the National Heart, Lung, and Blood Institute's National Cholesterol Education Program (NCEP).
"There are people who don't qualify for (statin) drug treatment at all," Cleeman adds. For example he says elderly people who are not in good health wouldn't be candidates, nor would those with liver disease or a hypersensitivity to the drug.
In general, the higher your LDL cholesterol ("bad cholesterol") level and the more risk factors you have (other than LDL), the greater your chance of developing coronary heart disease (CHD) or having a heart attack.
Some people are at high risk for a heart attack because they already have CHD. Others are at high risk for developing CHD because they have diabetes or a combination of risk factors for heart disease.
Below are major factors that increase your risk of a heart attack:
- Cigarette smoking
- High blood pressure or taking blood pressure medication
- Low HDL cholesterol or "good cholesterol" (less than 40 mg/dL)
- Family history of early heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65)
- Age (men 45 years or older; women 55 years or older)
- Obesity
- Physical inactivity
Even if your physician feels you need a cholesterol-lowering drug, the NCEP recommends that it be used in conjunction with making what it calls "therapeutic lifestyle changes", including a cholesterol-lowering diet, physical activity and weight management.
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External Source
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National Cholesterol Education Program
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This article was reviewed and updated June 2007.
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