Diet and weight loss should be your first strategy before taking statin drugs.
High levels of the wrong cholesterol can lead to heart disease, the primary cause of death for both men and women in this country. High cholesterol, also known as hypercholesterolemia, is a major risk factor for heart disease and stroke. While many people with high cholesterol levels are treated with drugs, mainly statins, medical experts say the first line of defense against high cholesterol should be changes in lifestyle—diet and exercise. Being overweight and eating certain foods can raise cholesterol levels.
What Is Cholesterol?
We need cholesterol, a waxy, fat-like substance that’s found in all cells of the body, to make hormones, vitamin D and substances that help us digest foods. Although our body makes all the cholesterol it needs, certain foods contain cholesterol and can raise our levels.
Cholesterol travels through your bloodstream in small packages called lipoproteins: both low-density lipoproteins (LDL) and high-density lipoproteins (HDL). It’s important to have healthy levels of both types. Too high a level of LDL, often called “bad” cholesterol, leads to a buildup of cholesterol in your arteries. On the other hand, HDL cholesterol, referred to as “good” cholesterol, carries cholesterol from other parts of your body to your liver, which removes it from your body.
The higher the level of LDL cholesterol in your blood, the greater your chance of getting coronary heart disease, while the more HDL cholesterol in your blood, the lower your heart disease risk.
New Research Focuses on Gene
The first medication in a new class of drugs that “silences” genes, inclisiran has been shown to halve cholesterol levels in patients at risk of cardiovascular disease, reported Science Daily.
Researchers from Imperial College London conducted the largest trial yet to test the safety and effectiveness of a technique, known as RNA interference (RNAi) therapy, which essentially switches off one of the genes responsible for elevated cholesterol.
The treatment is given twice a year, with or without statins, depending on the patient’s needs. Eventually, inclisiran could help to reduce the risk of heart attacks and stroke related to high cholesterol. However, because this is an early-phase study, and one of the first clinical studies on this type of drug, the study’s authors warn that more research is needed before the therapy can be marketed.
Source: “New 'gene silencer' drug reduce cholesterol by over 50 percent,” March 17, 2017, Science Daily.
A Good Diet
A recent study of the Tsimane indigenous people in the Bolivian Amazon, a forager-horticulturalist population, revealed that they have the lowest prevalence of coronary atherosclerosis (hardening of the arteries) of any population yet studied. An 80-year-old Tsimane had the same vascular age as a 50-year-old American. Tsimane diets are low in saturated fats and high in non-processed fiber-rich carbohydrates, and include wild game and fish. These indigenous people don’t smoke and are active for most of the day.
Our sedentary lifestyles and unhealthy diets work the opposite way and contribute to coronary heart disease. To keep our LDL levels low, medical experts first recommend a healthy diet:
The right fats. Fats are not necessarily bad for you; it just depends on which kind. Unsaturated fats are good for your heart and can help lower LDL. They include oils that come from plants such as canola, safflower, sunflower, olive, grapeseed and peanut. Other healthy fats include seeds, nuts, avocados and fish such as salmon, tuna, trout, herring and mackerel.
Saturated fats, which come mainly from animal products, raise your LDL level more than anything else in your diet and should be kept to a minimum—small portions every couple of weeks or so. These include meat and dairy products—egg yolks, red meat, shrimp, lobster, high-fat cheeses, butter and organ meats. As a rule, you should get less than 7 percent of your daily calories from saturated fat. Choose leaner cuts of meat and low-fat dairy for healthier options.
The unhealthiest option is trans fats, which increase LDL and also lower HDL. This can be a fatal combination because it increases the risk of heart attacks. Trans fats are added to food products, such as fried foods, cookies and crackers, to make them last longer. Publicity about trans fats has pushed many food manufacturers to phase them out, but you should read the labels on food products to make sure they don’t contain trans fat.
More fiber. Soluble fiber, such as that found in old-fashioned oatmeal (not the quick-cooking kind), apples, prunes, beans and brown or wild rice, keeps your body from absorbing cholesterol and lowers blood cholesterol levels. Research shows that people who ate 5 to 10 more grams of fiber each day decreased their LDL.
Plant sterols and stanols. These substances are found naturally in fruits, vegetables, legumes, nuts and seeds, and manufacturers have started adding them to processed foods, including margarine spreads, orange juice, cereals and granola bars. Because stanols and sterols are similar in structure to cholesterol, they help limit the amount of cholesterol your body can absorb.
Being overweight tends to raise your LDL level, lower your HDL level and increase your total cholesterol level. Even losing just 10 pounds can reduce your LDL by up to 8 percent. Combining exercise with a healthier diet can get rid of the pounds and lower your LDL cholesterol. Medical experts recommend 30 minutes of exercise a day and choosing something you enjoy, whether it’s taking a walk, riding a bike or swimming.
Alcohol and Smoking
While research has shown that smoking cigarettes lowers HDL, moderate drinking of alcohol (particularly red wine) increases HDL. Of course, there are other heart-related reasons to quit smoking. This habit harms the lining of the blood vessels and increases the risk of blood clots, which contributes to atherosclerosis (hardening of the arteries). And too much drinking can lead to serious health problems, including high blood pressure, heart failure and stroke. For women, drinking moderately means one daily drink; for men 65 and younger, two drinks, and over 65, one drink. Because of the risks associated with alcohol, the American Heart Association does not recommend drinking alcohol specifically to lower cholesterol.
The Next Step: Statins
Sometimes a good diet and losing weight are not enough to achieve healthy cholesterol levels. For example, an inherited condition can cause high LDL cholesterol. For those with this gene or for others who can’t reach the optimum cholesterol levels, taking a medication is the next line of defense. Statins, which inhibit the enzyme involved in the body's ability to produce LDL cholesterol, have proved to be the most effective cholesterol-reducing medication. In addition to lowering LDL, they also decrease triglycerides, which are another type of blood fat, and mildly raise HDL cholesterol.
There has been some concern over the years about statins side effects, including muscle pain, hemorrhagic stroke and myopathy. However, recent studies concluded that these issues affect only a small number of statin users and that statins’ benefits outweigh its harms.
In fact, statins have been recommended as a preventive tool for certain populations. The U.S. Preventive Service Task Force recommends that adults age 40 to 75 who don’t have a history of cardiovascular disease (CVD) but have one or more CVD risk factors (such as diabetes or hypertension) and have a calculated 10-year risk of a cardiovascular event of 10 percent or greater should use a low- to moderate-dose statin to prevent CVD.
Your risk is determined by comparing your information to a community-based population, which includes race, gender, age, total cholesterol, HDL cholesterol, blood pressure, use of blood pressure medication, diabetes status and smoking status.
For adults 76 years and older without a history of heart attack or stroke, the U.S. task force concluded that the current evidence is insufficient to determine whether the disadvantages outweigh the advantages of taking statins.
“Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication,” November 2016, U.S. Preventive Services Task Force.
“Indigenous South American group has healthiest arteries of all populations yet studied, providing clues to healthy lifestyle,” March 17, 2017, Science Daily.
“Statins or not? New study aims to help doctors and patients decide,” Sept. 8, 2016, CNN.
“Top 5 lifestyle changes to improve your cholesterol,” Mayo Clinic.
“11 Tips to Cut Your Cholesterol Fast,” WebMD.
“How to lower your cholesterol without drugs,” Oct. 27, 2015, Harvard Women’s Health Watch.
“What Is Cholesterol?,” National Heart, Lung and Blood Institute.
Blog posting provided by Society of Certified Senior Advisors