These are the current guidelines established by the “National Heart, Lung and Blood Institute” that all doctors are supposed to follow. The guidelines were set up to prevent atherosclerosis cardiovascular disease (ASCVD). They state that your physician needs to determine the number of risk factors that you have other than LDL cholesterol levels.Then, based on these factors you would be classified as:
A) low risk, B) intermediate risk or C) high risk.
Other risk factors include:
- Age (forty-five years or older for men; fifty-five years or older for women)
- Hypertension ( high blood pressure of 140/90 or more)
- Being on high blood pressure (antihypertension) medication
- Low HDL cholesterol (under 40 for men, under 50 for woman)
- Family history of pre-mature coronary heart disease in a father, brother or son less than fifty-five years of age or a mother, sister, or daughter less than 65 years of age.
Major Risk Factors
- □ Cigarette smoking
- □ High blood pressure
- □ Low HDL cholesterol (under 40 in men, under 50 in women)
- □ Family history of premature coronary heart disease
- □ Age (forty and over in men, fifty– five and over in women)
- □ Having ASCVD, diabetes, or obesity
- □ If HDL is 60 or more, this counts as a “negative” risk factor, and its presence allows you to subtract one risk factor from the total count. (Negative risk factor in this case means that high-HDL cholesterol lessens the risk of developing plaque.)
Total number of major risk factors: ___________
Subtract one major risk factor:
If your HDL cholesterol is 60 or more: ___________
Your major risk factor score: ____________
The Three Categories of Risk that Determine LDL Cholesterol Goals
RiskCategory LDL Goal
- *ASCVD and its *equivalents Under 100 (optional under 70)
- 2 or more risk factors Under 130 (Also, do the *FRS)
- 0 to 1 risk factor Under 160
If someone has two or more major risk factors, physicians are urged to determine the absolute risk of a cardiac event over the next ten years by using the *Framingham risk score. You can find your own Framingham risk score by going to: http://cvdrisk.nhlbi.nih.gov/calculator.asp and take the quiz.
Questions to Ask Your Doctor
- Can I try to change my diet first to see if my cholesterol numbers improve? And if so, what diet should I follow?
- Can you explain to me what my cholesterol numbers mean and how, according to the current guidelines, I meet the criteria for going on a statin drug?
- Can you calculate my Framingham risk score and tell me what my risk is of having a cardiac event in the next ten years?
- If diet doesn’t get my cholesterol to a healthier level, could I take other, safer medicines than a statin drug?
- Is the dose of a statin you are prescribing considered high, low, or average?
- You say that my *C–Reactive Protein (CRP) is high and that even though my cholesterol is not elevated; I need to go on a statin. But I do not have any other risk factors why would I need to go on a statin drug?
- Have you run the VAP cholesterol test to find out what the particle size is of my LDL cholesterol? (You want pattern “A” large size, will not stick to the arteries.)
- If LDL is pattern “A”: Since I have a pattern “A”, large size do the cholesterol numbers really matter? If so why?
- Fifty year old or older females: I’m a fifty – year old woman. Doesn’t that mean I don’t meet the criteria for being put on a statin? (According to the guide lines women 50 years or older should not be put on a statin drug.)
Side Effects of Statin Drugs
Muscles: The most common side effect of statins, myopathy, occurs with increasing frequency. The higher doses can cause symptoms ranging from mild myalgia (muscle pain), cramps, tenderness, and weakness to the rare but life threatening condition called *rhabdomyolysis. This disorder causes severe damage to muscles all over the body.
Tendons: Tendons attach our muscles to our bones, and tendonitis (inflamed tendons) and even tendon rupture have been associated with statin drugs. They found that with women taking statins had an almost fourfold increased risk of tendon rupture compared to women not taking statins.
Liver: Abnormalities of liver function, almost triples when high-dose statins are used as compared to low-dose statins. This is why your physician checks your liver enzymes about every six months when you are taking statins. If the liver enzymes are increased more than three times the upper limit of normal, the statin should be stopped. Statins can cause liver injury; they should not be taken by people who drink alcohol excessively or by those with known liver disease.
Joints: Shoulder stiffness is a common complaint in statin use. Joint pain can appear while taking a statin and then goes away when you stop taking the drug. Statin use in women sixty-five years of age or older led to almost double the risk of developing osteoarthritis, or “wear and tear” arthritis of the hip.
Nerve and Brain: Cognitive impairment, interference with our ability to think, concentrate, remember, and solve mental problems. This may be due to the fact that statin drugs decreases CoQ10 levels. People on statins were fourteen times more likely to have polyneuropathy (damage to multiple nerves) than people who had never been exposed to statins. For people who were treated with statins for two or more years, the ratio of definite polyneuropathy climbed to 26.4%. Long term statin use might substantially increase the risk of polyneuropathy.
Increased risk of Lou Gehrig’s disease: Postmarketing surveillance data (that is, information that has come to light after a drug has been released) have raised the disturbing possibility of increases in amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) – like symptoms in people taking statins. ALS is a disease of motor neurons, of unknown cause, that leads to muscle wasting, weakness, and eventual death. Fortunately, it is rare, there is no known cure.
Mitochondrial Dysfunction: Mitochondrias are microscopic energy factories found in all our cells. Statins have either unmasked or induced mitochondrial myopathies (any muscle abnormality) in people with previously undiagnosed mitochdrial defects.
Increases Diabetes: Statin drugs can cause blood sugar to rise. Thereby, increasing the risk of diabetes and can lead to a 25 percent greater risk of having a diagnosis of diabetes.
Birth Defects: If a statin is used when pregnant it can cause birth defects, severe defects of the central nervous system like spina bifida (open spinal cord), abnormalities of the arms and legs, cleft lip or palate, and severe abnormalities of the gastrointestinal and genitourinary tracts.
Increases Risk of Cancer: Taking Pravastatin (Pravachol) you would have a 25 percent increased risk of developing cancer. Pravvastatin appeared to increase the chances of developing precancerous colonic polyps. (Most colon cancers develop from polyps, but not all polyps have the potential to become cancerous. However, the larger the polyp, the more likely it is to become cancerous.) The risk of developing ployps was nearly 40 percent higher than for people not on statins.
CoQ10: Statins decrease the levels of CoQ10 (Also known as Coenzyme Q10 or ubiguinome): A molecule that is involved in energy generation by our cells and is need by the heart to function properly.
Please note: This is not a complete list of all side effects from statin drugs. These are the most commonly known side effects.
FDA Approved Statins
Fluvastain – Brand name: Lescol
Simvaststain – Brand name: Zocor
Atorvastatin – Brand name: Lipitor
Lovastatin – Brand name: Mevacor
Pravastatin – Brand name: Pravachol
Rosuvastatin – Brand name: Crestor
Interactions of Statins
Juices: Grapefruit juice and pomegranate juice should never be consumed when taking a statin drug. These juices inhibit enzymes that metabolize (break down) statins. This leads to higher blood levels of statins, which like increasing the dose of statins will increase the likelihood of side effects.
FDA Prescribing information on Simvastatin (Zocor)
Medications that should never be taken with Zocor
Brand names are in parenthesis
Antifungals: itraconazole (Sporanox), ketoconazole (Feoris,Nizoral), posaconazole (Noxafill) are all contraindicated (not to be used).
HIV Protease Inhibitors: saquinavir, ritonavir, indinavir, others are all contraindicated.
Antibiotics: erythromycin (goes by several name brands), clarithromycin (Biaxin), telithromycin (Ketek) are all contraindicated.
Antidepressants: nefazodone (Serzone) contraindicated.
Fibrates: (Medication that lowers triglycerides) gemfiborozil (Gemcor, Lopid) Are all contraindicated.
Immunosuppressants: Cyclosporine (Gengraf, Neoral, Sandimmune _ Capsules, Sandimmune_ Oral Solution) are all contraindicated.
Synthetic Steroid: (modified progesterone) danazol (Danocrine) is contraindicated.
Other medications that should not be administered with certain doses of simvastatin:
Antiarrhythmics: amiodarone (Cordarone, Pacerone) – do not exceed 10 milligrams of simvastatin daily.
Calcium Channel Blockers: verapamil ( Calan, Verelan, Verelan PM, Isoptin, Isoptin SR, Covera-HS), Diltazem (goes by several brand names), amlodipine (Norvasc) – do not exceed 10 milligrams of simvastatin daily.
Antianginals: (drugs used in the treatment of angina pectoris, a symptom of ischaemic heart disease.) ranolazine (Ranexa) – do not exceed 10 milligrams of simvastatin daily.
Particle Size of LDL Cholesterol
The particle size of LDL cholesterol does make a difference in whether or not LDL is a contributing factor in heart disease. The LDL practical size can be measured through a blood test. This blood test will grade the particles size to large or small. If your LDL particle size is large then your risk for heart disease is diminished greatly. Large LDL particles (Pattern “A”) do not have the capacity to “stick” to the arterial walls and cause plaquing (a fibrous cap that builds up in arteries affected by atherosclerosis causing narrowing of the arteries).You could think of the large size LDL partical size as: big, fluffy, cotton ball like. Small particle size LDL (Pattern “A”) has the capacity to linger for longer periods of time in the blood-stream. You could think of the small particle size: hard, and small like a BB. High blood sugar encourages glycation (bonding of fat with a sugar ) of the LDL particles. This leads to inflammation that will trigger the formation and growth of atherosclerotic plaque in arteries.
Additional Blood Tests That Need to Be Done But Usually Are Not Done.
Called: Lipoprotein testing
The only way for you to truly know where you stand in relation to your cholesterol is to actually measure the LDL particles. There are several tests your doctor can run. You may have to ask to have these blood tests done. Your doctor may not even be aware of them.
Nuclear Magnetic Resonance LipoProfile Test (NMR): Some groups, such as the National Lipid Association, are now starting to shift the focus toward LDL particle number instead of total and LDL cholesterol, but it still has not hit mainstream. Fortunately, if you know about it, you can take control of your health and either ask your doctor for this test, or order it yourself.
All the different lipoproteins have a unique magnetic signature, and this test uses a nuclear magnetic resonance technique to pick up on that signature. It can correctly identify the number of particles in each case.
It’s easy to get and all major labs offer it, including LabCorp and Quest.
Apoprotein B: Europe and other parts of the world, LDL particle number is more commonly measured using an indirect marker, apolipoprotein B (apoB). ApoB is a protein required for the formation of the LDL particle. About 90-95% of apoB particles are LDL particles, which makes apoB a fairly accurate measure of LDL particle number. If you live in a country where the NMR profile is not available, you can use the ApoB test to roughly determine your LDL particle number, and then use triglycerides, HDL, fasting blood sugar, blood pressure and waist-to-hip ratio to determine if you have insulin resistance.
**VAP (Vertical Auto Profile): The VAP Cholesterol Test is a direct measured lipid panel. It provides you with the most accurate, comprehensive and helpful cholesterol measurements available today. The VAP test directly measures LDL (So called bad cholesterol) and provides measurements for 15 lipid components. The routine cholesterol test calculates LDL and only reports 4 lipid components. ** Least expensive, easiest one to do and the most common one done.
Hereditary testing: The only people who may benefit from a statin drug are those with the genetic defect called familial hypercholesterolemia. Familial hypercholesterolemia (FH), is caused by inherited mutations in the LDL receptor gene. Someone with heterozygous FH (one parent contributes a genetic mutation) typically has a total cholesterol count of 300 to 400 mg/dL and a level of LDL in excess of 200 mg/dL. Homozygous FH (both parents contribute genetic mutations) is characterized by a total cholesterol level that can reach 1,000 mg/dL. Either type is deadlier than acquired hypercholesterolemia.
FH is not one of those rare genetic diseases, it is somewhat common. The prevalence of heterozygous FH in the U.S. is 1 in 500; about 600,000 young and middle-aged Americans have this disease. You will not find many older adults in this cohort because people with FH often do not live that long. Homozygotic FH is found in 1 in 1 million Americans and kills even sooner.
What Raises Your LDL Particle Number?
If the primary cause of heart disease is not high cholesterol, then what is? Part of the reason why statins are ineffective for heart disease prevention (besides the fact that the drug causes heart disease as a side effect) is that drugs cannot address the real cause of heart disease, which is insulin and *leptin resistance, which in turn increase LDL particle number. While some genetic predisposition can play a role, insulin and leptin resistance is primarily caused by a combination of factors that are epidemic in our modern lifestyle:
- A diet high in processed and refined carbohydrates, sugars/fructose, refined flours (Like 100% whole wheat), and industrial seed oils
- Insufficient everyday physical activity. Leading a sedentary lifestyle causes biochemical changes that predispose you to insulin and leptin resistance. As little as 5 to 7 minutes of interval type of exercise done 3 times a week would be sufficient to reduce cholesterol (if done correctly).
- Chronic sleep deprivation. Studies have shown that even one night of disturbed sleep can decrease your insulin sensitivity the next day and cause cravings and overeating.
- Environmental toxins. Exposure to BPA, for example, can disrupt your brain’s regulation of weight.
- Poor gut health. An imbalance in your gut flora (the bacteria that live in our gut) can predispose you to obesity and insulin and leptin resistance.
- Poor thyroid function. T3 hormone (which is the most active form of thyroid hormone) is required to activate the LDL receptor, which is what takes LDL out of the circulation. If you have poor thyroid function or low T3 levels, then your LDL receptor activity will be poor, and you’ll have a higher number of LDL particles. By addressing any thyroid issue you may have will reduce this problem.
Alternative medications that lower cholesterol that are not a statin
These medications may be safer for you to use than a statin drug.
Bile Acid Sequestrants or Resins (Brand names: Colestid, LoCholest, Prevalite, Questran, Questran Light): Your body uses cholesterol to make bile, an acid used in the digestive process. These medicines bind to bile, so it cannot be used during the digestive process. Your liver responds by making more bile. The more bile your liver makes, the more cholesterol it uses. So, less cholesterol is left to circulate through your bloodstream.
Nicotinic Acid (Brand names: Niacor, Nicolar, Slo-Niacin) : Nicotinic acid, or niacin, is a form of vitamin B. It appears to slow the liver’s production of certain chemicals that help to make LDL (“bad”) cholesterol. Nicotinic acid has also been found to lower triglycerides and raise HDL (“good cholesterol”) levels.
Fibric Acid Derivatives (Brand names: Atromid-S, Lopid, Tricor): Fibric acid derivatives, or fibrates, are used to lower triglyceride levels. Fibrates break down the particles that make triglycerides and use them in other ways in your body. Lower triglycerides can lead to increased levels of HDL (“good”) cholesterol.
Cholesterol Absorption Inhibitors (Brand name: Zetia): A cholesterol absorption inhibitor is used to lower levels of LDL (“bad”) cholesterol. This medicine can also be given in combination with a statin. Cholesterol absorption inhibitors work in the digestive tract by reducing the amount of cholesterol absorbed from foods you eat. It is important that you stay on a cholesterol-lowering diet while taking this medicine.
Side effects of non-statin cholesterol lowering medications
Bile acid sequestrants
- Stomach bloating or the feeling of being full
- Upset stomach
Nicotinic acid (niacin)
- Dry skin or a rash
- Upset stomach
- Throwing up
- High blood sugar
- Abnormal heart rhythm (arrhythmia)
Fibric acid derivatives
- Upset stomach
- Throwing up
- Flatulence (gas)
- Stomach pain
- Extreme tiredness
- Muscle pain and weakness
- Skin rash
- Hair loss
- Abnormal heart rhythm (arrhythmia)
Cholesterol absorption inhibitors
- Stomach pain
Many of these side effects are rare. Most people can take non-statin cholesterol-lowering medicines with few, if any, side effects. Tell your doctor right away if you have any of these side effects. Do not stop taking your medicine unless your doctor tells you to. If you stop taking your medicine without checking with your doctor, it can make your condition worse.
*ASCVD: Atherosclerotic Cardiovascular Disease
*C-Reactive Protein (CRP) or (hsCRP stands for high-sensitivity CRP): A protein in the blood that is an indication of inflammation. An elevated CRP level is a risk factor for developing atherosclerosis (Harding of the arteries caused by build-up of plaque in the arteries)
*Equivalents: Diabetes, Obesity, High Blood Pressure
*Framingham Risk Score (FSR): Is a short test that determines your risk for ASCVD over the next 10 years. It is base on the Framingham Heart Study: a hallmark study begun in the late 1940s in which two-thirds of the adult population of Framingham, Massachusetts, participated. The ongoing study sought to determine the risk factors for atherosclerosis (hardening of the arteries in which in which a complex substance called plaque builds up in the arteries.) To take the free test, go to: http://cvdrisk.nhlbi.nih.gov/calculator.asp
*Leptin: Is a protein hormone involved in the regulation of energy intake and expenditure by the body. Leptin is an important cytokine (proteins that serve as messengers between cells) which play a key role in the regulation of appetite, food intake and metabolism.
*Rhadbomyolsis: The most feared muscle disorder which is a side effect of taking statin drugs. It is a severe breakdown of muscle tissue. A rare side effect of statins but can lead to kidney failure and death. Usually causes severe muscle pain and weakness.
For more information on how to get healthy and stay healthy, go to: www.youralternativedoctor.com
Dr. Foley is an Advanced Nutritionist/ Chiropractic physician that specializes in nutritional rehabilitation of chronic and hard to manage health conditions. He has practiced over 24 years, lecturing weekly on how to get rid of belly fat, Hypothyroid, Hashimoto’s Autoimmune, Gluten Sensitivity and many other health topics. You can listen to Dr. Foley every Sunday at 2:00 PM central time on his radio shows “The Natural Health Care Show” on 99.7 FM Nashville, TN or on the internet “live” at www. 997wtn.com. Past show are available on his website. Dr. Foley takes a natural approach that is safe and effective. All health care programs are tailor made for the individual person. You can contact Dr. Foley at 5602 Nolensville Pike Nashville, TN 37211 Office Phone: (615) 333-0021 or firstname.lastname@example.org or www.Facebook.com/Healthandwellnesscenterdrfoley or Twitter @Drfoleybrian