Are you taking your statin that your doctor prescribed for you? Have you had a stroke or a heart attack or an abnormal left heart catheterization and have stents in your heart? If you had then you should be taking a statin. If you had an elevated Cardiac CT calc score, then this would indicate a high risk for coronary artery disease and you should also be started on a statin.
Most patients want to get off medications
Countless patients of mine complain about the amount of medication they take. They specifically ask me to address their medicines and say that they want to get rid of unnecessary medicines. Patients appear to understand that statins reduce cholesterol levels. I observe in the office countless times how effective the lowering of the bad cholesterol (LDL) is when we review their fasting labwork.
Eating a fast food diet will lead to high cholesterol
Most often patients understand that by reducing the saturated fats in their diet, their cholesterol levels should improve. Do you know what saturated fats are? Well glad you asked! Saturated fats are in processed food, fried foods, and fatty meats. If the patient limits eating fatty fried foods and eat more vegetables and fruits that are high in antioxidants, there should be an improvement in the cholesterol levels. Despite my patients understanding this, they seem to think that if they change their diet or get their LDL numbers under control, they will not need their statins anymore.
Statins have been given a bad rap!
Statins have been a rather controversial drug over time and have literally been given a bad rap. The most studied statin in the early years was Atorvastatin (Lipitor). It is a potent statin. Statins side effect profile include muscle weakness and muscle pain, muscle breakdown and liver failure. The side effects have put off patients taking the medications. In addition, negative media has exacerbated the response.
Statins are lifesaving
There are newer statins on the market now. The most popular statin that is high potency and low side effect profile are Rosuvastatin. These newer medications are metabolized in different pathways in the liver and so consequently have less of the side effect profile. We have now studies that confirm the benefits of statin are actually plaque stabilization, plaque reduction, and anti-inflammatory.
High sensitivity CRP is a marker for inflammation
We often use the High sensitivity C-Reactive Protein (HS-CRP) to look at the amount of inflammation in the body. Now, this marker is not unique to the heart and it can be elevated in the setting of an autoimmune disease, infection or recent injury. It does help guide the conversation and the need for further intervention.
Statins limit the inflammation in the artery
In the American Journal of Cardiology, in February 2003, Libby et al studied the mechanisms of plaque stabilisation. The study found that statins lower the amount of cholesterol that made up the plaque and it decreases the inflammation in the blood vessels.
Statins stabilize plaque
Statins stabilize plaque. Many patients do not know this about this medication. My analogy for this is the story of Gulliver’s travels. Do you remember how the Lilliputians tied Gulliver to the ground with lots of little ropes? Though Gulliver was a giant, he was immobilized by the ropes. Picture the giant, Gulliver, as the large unstable plaque in your blood vessel and the Lilliputians as the statin in your bloodstream. The statins act to stabilize the plaque by throwing little imaginary ropes over the plaque to hold it in place.
Statins act like scaffolding when there is construction
The other analogy I like to give is that the statins act like scaffolding when you are building a house. Scaffolding helps to stabilize the structure you are building. This is what the statins do! The medication actually stabilizes the plaque so that the plaque cannot easily break off. The mechanism of a heart attack is when you have plaque-laden arteries and the plaque breaks off.
Imagine the plaque as a twig in a roaring river
Plaque is inherently unstable. I like to think of the analogy that the cholesterol plaque is the equivalent of a twig in a roaring river. This twig has a very high chance of moving in the river due to the force of the water. When the twig breaks off, it will float downstream and may get stuck on a boulder or a more narrow part of the river.
In the blood vessel, when the plaque breaks off, there is a microscopic tear in the blood vessel wall. The body responds to the microscopic tear in the blood vessel wall by triggering a cascade of inflammation and sending a blood clot to help stop the bleeding. The blood clot is however also unstable and it can break off and then get stuck downstream in a narrowed plaque-laden artery. When this occurs the person starts to have the symptoms of a heart attack.
The artery is bottlenecked by plaque
Imagine it is a highway with 5 lanes of traffic and suddenly there is a car accident and the freeway becomes bottlenecked down to 1 small lane of traffic. If an oversized semi truck is hurtling along, it can get stuck in the bottleneck. You then have a major issue with traffic congestion. When this occurs in a human, the patient has a heart attack. No blood supply can move past the obstructed blood vessel and the muscle tissue further downstream starts to die. This is why physicians tell you to take an aspirin. Aspirin has an antiplatelet effect and will prevent you from making a blood clot. Aspirin will also help to break down the blood clot you have already made and limit damage from the heart attack.
How do you prevent a heart attack?
So how do you improve your risk factors and prevent having a heart attack? The answer is complicated by many issues. How much burden of plaque do you already have in your blood vessel? What is your family history is in terms of heart disease? Are you a smoker or when did you quit smoking? How high is your cholesterol level? How elevated is your High Sensitivity-CRP? Have you had a Cardiac CT calc score done yet? Do you have Diabetes? Do have other inflammatory illnesses or infections.
Optimize your lifestyle and keep taking your statin
If you are on a statin you should stay on a statin for plaque stabilization and the anti-inflammatory effect. If you eat poorly, you should change your diet to a diet rich in brightly colored vegetables and fruit. You should limit junk food and eat lean meat and foods high in omega 3’s like fish. If you are a smoker you need to quit. Smoking introduces free radicals into your body furthering the cascade of inflammation. Statins are not drugs that should be stopped if your numbers are better. Statins are medications that stabilize plaque and save lives.
Contact me at email@example.com if you need more information on how to improve your health, need to optimize your diet and start living life.