“My MD says that my LDL is high. She wants me to go on statins. I’ve heard bad things about them and I don’t know what to do.”
We hear this all the time and hopefully this will help you be an informed partner in managing your health.
Think of statins like penicillin, the world’s first antibiotic. When penicillin was introduced in 1942, the mortality rates from bacterial infections dropped from 18% in WWI to less than 1% in WWII. And though it is used today, we know penicillin has limitations; it does not work on all bacterial infections and for some people, it can be toxic.
The indications for using statins are no different. Since their debut in 1987, statins have been credited with reducing deaths from coronary heart disease by 28%. However, like penicillin, the use of statins in primary prevention are limited to those patients with certain cardiovascular conditions. Unfortunately, it has become almost unethical to not prescribe a statin for everyone who presents with a high LDL-c. (LDL-concentration is the standard ‘biomarker’ – a measurable substance in the blood – for assessing cardiovascular risk.)
Statins can, very effectively, reduce LDL-c by reducing cholesterol production throughout the entire body and increase the ability of the receptors to help remove any excess. This is a good thing except when
1)…the high LDL-c isn’t caused by too much cholesterol production.
Statins can drop a person’s cholesterol synthesis in the muscles and brain to a point that causes muscle pain and mild cognitive dysfunction, respectively. This is when a statin is not indicated. A better test for these people with high LDL-c would be a biomarker that indicates the body’s inability to remove cholesterol. This biomarker is called ApoB and prescribing a drug designed to improve ApoB receptor function might be a more effective solution.
2)…the high LDL-c is caused by abnormally high amounts of triglycerides (TG) or the genetic Lp(a) regardless of the person eating healthy and exercising.
Both of these conditions cause an increase in LDL-p (particle number) and LDL-c and statins are ineffective against them. The indication for other drugs that effectively reduce these specific biomarkers and thereby reduce LDL-p and LDL-c might be more appropriate.
If your cholesterol levels are not in an acceptable range, ask your MD to do a little more investigating. Tests that measure biomarkers such as ApoB, Lp(a), and LDL-p will give your MD a better indication of what is going on in your arteries and veins. Your MD can then decide if you are a candidate for a statin, a statin in combination with another drug or a drug that more appropriately addresses the problem that is putting you at risk for cardiovascular disease.