Category: Statins

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Diet Heart Health Hyperlipidemia Prevention Statins Treatment

How the Body Regulates Cholesterol

In this article, I wanted to provide a basic overview of cholesterol regulation in the body. I share such articles with my heart health coaching clients whenever necessary. How the body regulates cholesterol is relevant to choose the right method of controlling cholesterol levels.

Cholesterol Regulation

Cholesterol is quite essential. The following key players regulate cholesterol in the body:

  • cells lining the intestine
  • liver
  • pancreas
  • intestinal bacteria

The food we eat has some form of cholesterol which becomes absorbable after manipulation by intestinal bacteria and pancreatic enzymes.

Cholesterol can enter the bloodstream also through the bile system. Whether you still have a gallbladder or not, your liver will produce cholesterol pumped into the intestines.

Cholesterol Absorption Varies

Some individuals are hypoabsorbers of cholesterol. No matter how much high cholesterol foods they consume, their intestinal cells don’t take up much of it.

Others are hyperabsorbers of cholesterol; even the lightest meals can have every bit of its cholesterol extracted and pumped into the bloodstream.

Cholesterol Regulation and Treatment Options

For my hypoabsorber clients, I am less concerned about their dietary cholesterol intake. Their cholesterol production in the liver would be a more important factor.

The hyperabsorbers will benefit a lot from a particular dietary change. Sometimes it helps to cut back on saturated fats, but eating times and gut bacteria are also important criteria.

Dietary change? Statin therapy? Ezetimibe? Evolocumab?

To answer that, I need more information about the person. A generic cholesterol test won’t always tell us the whole story.

The Liver’s Cholesterol Production

How cholesterol is regulated in the body has a lot to do with the liver. This fleshy organ on the right upper quadrant of the abdomen produces LDL, HDL, and VLDL particles.

Statin drugs decrease the production of cholesterol molecules in the liver.

The liver also has LDL receptors and absorbs cholesterol.

From fatty liver to elevation of liver enzymes to problems with the gallbladder, it’s important to consider the health of this organ when assessing my clients.

The Role of Gut Flora and How Cholesterol is Regulated

Some bacteria in the gut convert free cholesterol molecules into a stanol chemical that intestinal cells cannot absorb.

We could call these beneficial bacteria. They can help slow down the absorption of cholesterol for certain individuals.

Ezetimibe is a medication that works similarly, blocking the absorption of free cholesterol molecules.

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Heart Attacks Heart Health Statins

Statins for Heart Disease Prevention

Statins are prescribed either for existing heart disease or to prevent heart disease. Preventing heart disease is referred to as a primary prevention strategy. Let’s discuss if statins for heart disease prevention are as effective as advertised and what other factors one should consider.

Statins to Prevent Heart Disease

Statins have gone through a lot of recommendation changes over the years. Some statins stand out more than others.

But there are still a lot of disagreements when it comes to using statins for the prevention of heart disease. This means using a statin for someone who is otherwise healthy but wants to prevent a heart attack.

In western medicine, it’s the standard of care to prescribe this medication to individuals with high cholesterol or diabetes, hoping it will prevent a heart attack.

The Actual Numbers

Think back to your high school class. Let’s say you had 150 people in that class. If everyone in that class took a statin to prevent a stroke, then only 1 out of 150 would benefit.

In other words, 150 people would have to be treated to prevent 1 stroke. And 100 would have to be treated to prevent 1 heart attack.

We refer to this as the NNT – the number needed to treat.

The Harm of Statins

Fortunately, statins are relatively safe medications. Yes, some people develop terrible side effects with them. Some even can develop diabetes or muscle or liver damage.

Obviously, we wouldn’t prescribe medication unless it was absolutely necessary. If only those who really needed this medication took it, the risk of statins would be far lower than its benefits.

But the actual harms of this medication – 1 in 50 would potentially develop diabetes, and 1 in 10 would develop muscle pains or damage.

Preventing Heart Disease

So what does work if not statins?

Controlling your blood pressure, eating a healthy diet, and maintaining a healthy activity level seems to decrease your risk of a heart attack.

Other factors like stress and cholesterol matter but are closely tied to your diet and activity levels.

The Individual Factor

As a physician, I don’t like talking about medication or an illness in general terms. Each person is unique, and all things matter. I learned this phrase from my functional nutrition course.

Each person is unique, so we must approach each person’s risk factors and decisions individually.

All things matter means that the patient’s individual abilities and lifestyle factors determine what intervention we choose or don’t choose.

Categories
Heart Health Hyperlipidemia Statins

Do Statins Prevent Heart Attacks?

For the right patient, a statin is a lifesaver. But do statins prevent heart attacks? They are used to lower cholesterol levels, but some will still suffer a heart attack even when taking a statin.

It’s essential to understand this concept. You can still suffer a stroke or a heart attack while taking a statin medication.

Primary & Secondary Prevention

Statins are a group of medications such as simvastatin and atorvastatin. There are others, and each has its place in managing serum lipids.

A statin is prescribed to some patients to lower their cholesterol and prevent a heart attack, stroke, or other atherosclerosis-related medical conditions.

This primary prevention strategy is used for those who haven’t yet had a heart attack or stroke. But many will have had such cardiovascular events and be put on a statin – we refer to this as secondary prevention.

Secondary prevention means trying to prevent a second or third heart attack or stroke.

Statins and Heart Attacks

Western medicine’s big gun remains the statin drug. Even with this, nearly 25% of those on a statin still can suffer a heart attack.

I fished this number from a few studies and my personal experience with my patients. Now that even more patients are on statins, this number likely is higher.

Heart disease is a complicated process. Simply lowering your cholesterol isn’t enough to entirely prevent a heart attack. It’s a big step in the right direction – for some.

Preventing a Heart Attack

A statin won’t prevent a heart attack. It will lower a person’s cholesterol. This lower serum lipid profile may slow the progression of atherosclerosis.

A heart attack can happen in those with normal cholesterol levels. This is why it’s essential to address heart health not just from the serum lipid perspective but from a broader angle.

Whether you’ve already had a heart attack or are trying to prevent one in the first place, it’s crucial to figure out what your risk factors are.

Some of us can easily change our diets, and others will have a hard time with diet but can readily improve their exercise capacity. You’ll significantly improve heart health regardless of which strings you pull on.