By Perry J. Weinstock, MD, FACC, FNLA
Heart disease, or more specifically, coronary artery disease, is the leading killer of adult men and women in the United States.
Because of this staggering statistic, it’s vital that physicians, nurses and health educators help patients identify risk factors for coronary artery disease and work on prevention.
Believe it or not, we did not understand the effects of cigarette smoking, elevated blood pressure, and elevated cholesterol on heart health until about 50 years ago. While we know that there is a genetic link to coronary artery disease, unfortunately the American lifestyle (high fat diet, lack of exercise) is as much to blame for the deadly condition as the genes of our parents. Fortunately, unlike the generations before us, we now have options for people to learn to take better control of their own health.
Managing cholesterol through diet and exercise is one of the best ways to control heart health. Sometimes, patients successfully change their habits and reduce their cholesterol without medications. But for those with a genetic (inherited) lipid problem, lifestyle changes will not be enough. These patients will need medication to overcome their tendency toward elevated lipids (high cholesterol).
Lipid is a broad term that includes the different fats in our bloodstream. These fats are composed of cholesterol and triglycerides which are carried in “containers” called lipoproteins. Cholesterol is a waxy substance that is an important part of cell membranes, hormones, and our brain. Too little cholesterol could actually be harmful. However, in America we have an abundance of high fat foods which can lead to high cholesterol.
Numerous medications are available to lower various lipid levels, but only a type of medication known as the statins have consistently shown that they not only lower bad cholesterol, raise good cholesterol and lower triglycerides, but they also help people to live longer. You know these medicines by the trade names Lipitor, Crestor, Zocor, Pravachol, Lescol, Mevacor, and Livalo. Over the past few years some of these “branded” medications have become available as generic substitutes and you may also know them as simvastatin, pravastatin, or lovastatin. These are all prescription medications and not available over-the-counter. In order to receive them you must consult with a physician and should have periodic follow-up to assess safety and effectiveness.
Statins have been shown in numerous research clinical trials to reduce the risk of heart attack and death from a heart attack by approximately 30 percent. No other therapy has been shown to reduce this risk by this much. However, many patients are reluctant to take statins due to real or perceived side effects. One common side effect is muscle aches, but we know that not all aches are due to statins, so patients should not avoid this important therapy for that reason. Patients should discuss any difficulties with statin therapy with their physician before stopping the medication. Alternate statin therapies that are tolerated more easily could be available. If you cannot tolerate one statin, this does not mean you will have the same problem with another.
Patients need to be open-minded and physicians should offer sensible options. If you are struggling with a cholesterol problem and you are not achieving your goals, seek the advice of a physician with special expertise in the science of cholesterol and other lipid disorders. Remember, coronary heart disease is a preventable problem. Work with your physician to achieve the cholesterol goals you deserve.
Dr. Weinstock is Head of the Division of Cardiovascular Medicine at Cooper, and Director of Clinical Cardiology , Associate Professor of Medicine at Cooper Medical School of Rowan University. This article first appeared in the Courier-Post.