Should You Take Statins?

Cholesterol is only one of several factors that affect the risk of heart disease. Others include high blood pressure, smoking, lack of exercise, family history, poor diet, and being overweight or obese. One study estimated that 80 percent of heart disease could be prevented by changes in three lifestyle factors- diet, exercise and smoking. And yet the medical establishment remains focused on cholesterol levels and taking statins.

When I was in medical school, a total cholesterol below 240 mg/dL was considered acceptable, but over the years that was lowered to 220 and then to 200 by various advisory groups. In 2004, new guidelines that made LDL cholesterol the primary factor in deciding to prescribe statins were so stringent that millions more Americans were prescribed these drugs. Subsequently, it was reported that all but one of the nine members of the panel that wrote the guidelines had received funding from statin manufacturers.

A consortium of heart organizations came out with yet a new set of guidelines in 2013, based on your risk of heart attack in the next ten years, determined by an online calculator. You should take a statin, they advised, if your risk is 7.5 percent or more. Using the results of the online calculator, upwards of 70 million Americans, including almost everyone over age sixty-five, should be taking these drugs. Fortunately, a recently revised calculator (https://sanjaybasu.shinyapps.io/ascvd/) dials back the number of people advised to take statins.

Missing from these advisories is any consideration of the dangers of taking statins:

-One in five patients taking statins have side effects, with muscle pain being the most common.
-The FDA has issued safety announcements cautioning statin users about memory problems, diabetes, and liver function.
-Acute memory loss is four times more common in statin users in the first days of treatment.
-People taking statins have nearly a 50 percent higher risk of developing type 2 diabetes.
-Other side effects include cataracts, liver and kidney damage, fatigue, and mood disorders.

If you have had a previous heart attack or stroke and/or if you have a 20 percent risk of having one in the next ten years using the new calculator, you should consider taking a statin if you are not able to reduce your ten-year risk using lifestyle methods alone. In people with familial hypercholesterolemia, a genetic defect causing high levels of LDL cholesterol, statins are usually recommended. These people can also lower their risk of heart disease, as well as the dosage of statins needed, by diet, exercise, and smoking cessation.

While it is easier to take a pill, most of us could take a thirty-minute walk three times a week, up our intake of fruits and vegetables to five servings daily, and cut down on highly refined carbohydrates. Losing weight and stopping smoking are more difficult but can be done with proper motivation. Given the choice, what would you do? Change your lifestyle or take a pill? As the evidence of serious side effects from statins continues to grow—diabetes, cataracts, muscle damage, even dementia—the risk benefit equation tilts dramatically toward not taking them at all.

Disturbing News about Acid Reflux Drugs

A new study, reported at the November 2016 meeting of the American Heart Association, revealed a 20% increased risk of stroke in people taking proton-pump inhibitors (PPIs). This is on top of another study which found twice the risk of death from heart disease in people taking them. This is disturbing news, since experts estimate that seven out of ten people taking PPIs do not need them.

Proton-pump inhibitors are prescribed for acid reflux, also called GERD, and include Prilosec, Prevacid, and Nexium. They are blockbuster drugs, earning $13 billion each year in the US alone. While the approval of PPIs by the FDA was based on people taking them for only two weeks, many take them for years. Other dangerous side effects of PPIs include:

Vitamin D deficiency
Diarrhea infections
Pneumonia
Bone Fractures
Dementia
Kidney disease

Most of these side effects are because PPIs suppress the production of stomach acid, which you need to absorb important vitamins and minerals, such as calcium. PPIs also can destroy friendly bacteria in your stomach, paving the way for infections. The irony is that the vast majority of cases of acid reflux are not because of excess stomach acid. It is caused by weakness of a muscle that lets acid back up into the esophagus from the stomach.

There are several simple things that you can do to reduce acid reflux:

Lose five to ten pounds
Avoid tight clothing around the waist
Avoid certain foods—garlic, onion, tomato sauce, fatty and fried foods, caffeine
Eat several small meals throughout the day and wait 2-3 hours after dinner before going to bed
Elevate the head of your bed to help gravity keep food in your stomach

Unfortunately, if you are taking a PPI, it is very difficult to stop. This is because of a phenomenon known as rebound hyperacidity, whereby stomach acid actually increases after stopping a PPI. Tapering off these medications gradually and taking a simple antacid, such as Tums, Maalox, or Di-Gel, will help you to manage symptoms until your stomach acid returns to normal. Also, there are natural alternatives for acid reflux that you can use:

High-fiber foods, digestive enzymes, and probiotics
Aloe vera juice, licorice, apple cider vinegar, and slippery elm
Acupuncture and Chinese herbs
Stress reduction tapes, meditation, exercise

If your doctor has prescribed a PPI, talk to her about stopping it. The risk of serious side effects greatly outweighs its usefulness.

The study on PPIs and stroke can be found at: http://circ.ahajournals.org/content/134/Suppl_1/A18462. References for other studies on PPIs can be found in my book to be published in April.

Great News About Heart Disease

My father died of a heart attack when I was only sixteen. He was 58 and it was the third one that he suffered, his first at age 44. So heart disease is a subject close to my heart, no pun intended. And as you probably know, heart disease tends to run in families.

That’s one reason I am excited to tell you the great news about a recent medical study. The authors reported that your chances of having heart disease can be cut in half by following only three of four positive lifestyle practices—not smoking, not being obese, exercising regularly, and eating a healthy diet. This was true even for people like me with a strong family history of heart disease. And these lifestyle practices are easy enough for most of us to achieve. Specifically, they are:

Not currently smoking
Not being obese—this means a Body Mass Index less than 30. You can google BMI to get the formula for determining yours, based on your height and weight
Exercising regularly—this was defined in the study as physical activity once a week or more, less than I would expect
Healthy diet pattern—eating an increased amount of fruits, nuts, vegetables, whole grains, fish, and dairy products and a reduced amount of refined grains, processed meats, red meats, and sugar-sweetened beverages

The study found that those having three of the four lifestyle factors had half the risk of heart disease compared with those with one or no factors, even in people with a high genetic risk of heart disease. Having four of these factors should reduce your risk even more, although the authors did not report this in the study.

If you are already meeting these goals, Good on ya! as my friend from North Dakota says. If not, get busy making these positive lifestyle changes. Not only will you decrease your risk of heart disease, you will also feel better and improve your overall health.