We have no compulsory system for reporting the adverse effects of prescription medications, so how do we know the risks? We need to require that adverse effects be reported.
I took 20mg, then 40mg for a short time, then 20mg again of simvastatin/Zocor. I was age 69. I took the drug for SEVEN months only.
Within weeks, I had incipient foot cramps. At 7 months, I woke up screaming, both legs locked up from the knees down, like blocks of wood. My life for the next TEN YEARS was turned into a nightmare.
Would I have taken this drug if the doctor had told me that his practice had received over $300,000 from the drug company? No, I wouldn't have! When I asked about possible adverse effects, the doctor told me that "Some people think statins should be in the water supply." That safe, huh?
With HDLs of 88, triglycerides of 61, and Total Cholesterol/HDL of 3, I asked the doctor, why a statin. The answer: because my cholesterol was "high"? I should have asked the doctor if he was. There was a clear contradiction: ratios told me I was in great shape and with very low odds of heart problems.
But heck, by 2013 my age alone put me in the statin category, with money fully in the mix: the majority of the 2013 "expert" panel on statins had financial ties to the industry.
Books like "Overdo$ed America" show how we're turning the last ten years of our lives into chronic illness. We're 43rd among nations in lifespan. China, in 2016, first passed us in healthspan--years of healthy life.
1
This article is so dated. The theory that high cholesterol causes heart disease has been largely disproven. For most people, the root cause of heart disease—and of most chronic diseases—is inflammation. So what causes inflammation? The usual suspects: processed foods, sugar, stress, smoking, obesity, and lack of exercise. In fact, cholesterol is protective as we get older; our bodies and brains need it. Studies that are not pharma-funded consistently show that people with high cholesterol live longer and feel better than people with low cholesterol. At 67, mine is 350+ and I embrace it. My CRP (a key measure of inflammation) is very low at <.05. I never get sick, I’m drug-free and strong as a horse.
3
4 months ago, having the same issues as you had, I turned to acupuncture and Traditional Chinese Medicine. After only 2 initial acupuncture treatments and 4 months of taking a Chinese herbal called Hawthorne Extract, my LDL is down 55 points! It is now within normal range and we are backing down on the supplement to see where I can level off with it. I was determined not to go on a statin and am please to say that TCM certainly worked for me.
1
Can anyone please explain how a naturally occurring substance produced by the human body, through many epochs of evolution (or for those creationists- put there by God) can somehow be unhealthy ? There is a condition where cholestoral production is out of control familial hypercholesterolemia, that's not what we are talking about here.
2
@Jerome Changes in diet over the last 100 years. Processed food. A lot of food. Obesity, etc.
1 - yet another all male study.
2 - the highest absolute risk reduction was 5%, for the majority of the patients it was 2-3%.
Using relative risk assessments in this case gives a very over-optimistic view of the benefits.
And all of these studies were funded by big pharma.
5
dear jane, have you ever considered a WHOLE FOOD PLANT BASED DIET. please read dr. michael greger's book on how not to die. it provides great evidence on using our greatest medicine....FOOD. the mediterranean diet would aid the reduction of cholesterol but your diet still contained lots of saturated fats and sources of cholesterol.
i as a physician have been transformed by this diet and saw my cholesterol plummet in less than 2 months on this.
statins have such significant side effects for some....
3
@lola4md
Cholesterol-lowering through diet has been tested for decades. It succeeds in lowering cholesterol, but fails at reducing heart disease or all-cause mortality.
Almost as if cholesterol were not really the problem...
1
An interesting review paper on the significance of LDL and heart disease:
https://doi.org/10.1080/17512433.2018.1519391
The Title is: LDL-C Does Not Cause Cardiovascular Disease, A comprehensive review of the current literature.
This paper changed my mind and convinced me staying off statins was a good thing to do.
7
I am 66 years old and have had high cholesterol most of my adult life. I am slim and active and always watched what I ate for health and cholesterol. My doc suggested statins and I and my husband both decided against taking them.
In September I switched to a very low carb diet. Lots of meat fish and chicken- nuts- butters and cheeses. In January I was nervous about going for my yearly doc visit. Well surprise- LDL’s and Triglyceride levels went down- HDL’s went crazy high.
My non expert conclusion? When I eat cholesterols my body doesn’t have to make them and when my body makes them it produces too much.
We are all different. Prescribing statins for 90% of people over 60 can not be the right answer for all.
7
Thank you, I think I am going to be as unlucky as you are and this helps me feel better about trying a statin.
As I often note, the author and many of the journalists who furnish material here are not fluent in statistics. Often the justification for a medical intervention consists of "50%" or "60%" or some significant sounding number, when it really represents a change of 2 to 3 in a base of, say... 400? Meaning instead of two cured patients there now are three; 50% better? References of experimental results should not be presented without the underling base numbers.
Oh, and yes, I count myself lucky to have escaped the statin long-term population study my peers are enduring for science. One month of misery was enough for me. I guess I rejoined the control group
8
My family has a history of heart disease. My brother, mother and father all died from it. Lifestyle a big part of it including smoking. My father ignored medical advise, my brother had no medical advise, my mother had care but was very inconsistent with diet and exercise. In my familiar context I decided to try and prevent a heart attack if I could. Statins have help me with my cholesterol. I have not had muscle pain. Exercise and a heart healthy diet are part of my practice. I am 67 this April and if I live to 72 I would have lived longer than my immediate family. No heart attack yet. Regular visits to my GP and cardiologist. I have always been a non-smoker. I am hoping my prevent defense works. Statins are part of it.
6
@Bill
Good for you for taking control of your health!
1
I’ve been having statins for the past 11 years, as recommended by my cardiologist. No muscle pains. No diabetes. I’m a believer!
2
I had a heart attack at age 46. I was in good shape, non smoker, some family history but those with heart disease in family were smokers. It took me a week and 2 ER visits to convince the Drs that something wasn't right. After heart attack, I was told you are young, this was probably a fluke, stay on plavix for a year, here is your nitro in case you have symptoms again, get to ER. This was from a well respected cardiologist. I was scared to death that I would have another attack. Found Bale/Doneen online and this book, "Beat the Heart Attack Gene". Saved my life. Found a Dr. that practices the Bale Doneen method for heart attack prevention. Have been doing great for the past 5 years. I have a CIMT test done every year. When I was 46, my arterial age was 68, through diet and meds, it is now 56. The CIMT test is so important. My plaque was NOT inside my artery. It was in the wall of the artery, undetected. Inflammation caused it to rupture the wall and a blood clot formed to repair the wall, causing blockage. PLEASE check out the Bale/Doneen method for heart attack and stroke prevention. Especially if you are a woman as heart disease kills more women than ALL cancers COMBINED.
6
my family has a late onset muscle disease & none of us should ever have been put on stations. I was on them for 10 years as a precautionary medicine because I am also T2 diabetic. I lost 10 years of my kids growing up due to severe muscle pain & memory fog. I thought it was inevitable until I saw the movie Statin Nation. I went off them & w/in 6 mos, I felt better than I had in years. I can now walk, do yoga & work out again. Genetically, I should never have been put on them. Turns out, they can cause or exacerbate type 2 diabetes! They are not the benign candy that doctors hand out so freely.
9
Statins cause permanent nerve terminals damage therefore when you stop statins the pain might not go away since it has become chronic.
3
@Thinker26 Statins deplete CoQ10 in the cell. Everyone who is on statins should be told to also take CoQ10 with the drug to decrease side effects.
2
Dear Jane, It appears that you still buy into several misconceptions about statins, cholesterol, diet and the Cardiovascular Risk Calculator. First, only the drug company sponsored research shows significant benefit from statin use. All other studies, including in Britain, show little to no benefit and much harm. Second, cholesterol is not a disease but an essential chemical for body function. HDL and LDL levels are your body's attempt to regulate metabolism. LDL level has no correlation with cardiovascular disease risk. Insulin resistance is a much better indicator. Saturated fats are good food because they do not cause insulin spikes in your blood serum and they are natural, unlike some of the things you listed as good. Finally, the CRC calculator is only good for large group diagnostic prediction. It says very little to an individual patient. A cardiac calcium measurement is good for the individual. In summary, there is no conclusive evidence that taking statins does anything good for your heart but there is clear evidence it harms your body and even your heart. Sadly, your article is behind the times.
20
@Brian Landsberger
I’m afraid if I followed your advice I’d probably be dead. Some of my family has hereditary cholesterol. I’m 74. I’ve been on various cholesterol meds since I was 45. Two years ago I had three stents in the major arteries. I eat right, exercise and take Chestor but the numbers still wouldn’t go down. I even looked st 20 pounds. Recently I started working with a nurse practitioner and he put me BACK on zetia and fish oil with the Crestor. Mind you I had taken all these prior at one time or another. Lo and behold! My scores went WAY down. Amazing. I still think they got my scores mixed up! He said that sometimes things just work together and they did for me this time. He was ready to put me on some key of infusion shots. Not now.
1
Wow. Too much here to even start with. Please jettison all of that and return to square one.
1
If your high LDL won’t budge and you are eating a whole food, plant-based diet, that’s one thing. But if you aren’t, give it a try!
Also, vaccines are preventive, whereas statins treat the disease of hypercholesterolemia, which is — in most cases — caused by lifestyle, including the Standard American Diet (SAD.)
Jane Brody recommends oil in her article! She is not a dietitian, and as a physician, her nutrition training is likely minimal at best. This is irresponsible.
5
Statins treat risk for and prevent atherosclerotic events. They happen to do it by lowering LDL cholesterol, which is determined by genetic factors and by dietary ones as well.
8
If hyperlipidemia is of genetic origin it cannot be treated by anything but statins, unfortunately...
@MD
Statins are anti-inflammatory and anti-coagulant drugs. "Cholesterol lowering" is likely a side effect.
LDL cholesterol, all by itself, has never been demonstrated to be _causal_ in heart disease. But it sure has been profitable to medicate!
6
One correction to your otherwise factual argument in favor of considering statins: the expert advice to “treat to target,” i.e., to 100 mg/dl, or 70 mg/dl, or whatever, is not supported by evidence. The risk reduction attributable to statins is associated with the absolute reduction in LDL. For example, a decrease from 200 to 150 achieves equivalent benefit as a decrease from 150 to 100. It is the “50” that matters. Another issue that deserves mention is that statins are very effective for people who have already had a cardiovasculr event. The benefit in people who have not had an event is more controversial and desrves close scrutiny, one case at a time. This is where “shared decision making” is most important.
11
Couldn't get thru all the comments but the biggest red flag in Brody's diet is Canola oil. It's an industrial seed oil that is horrid for you - do some quick research. The rise of industrial oils is the one thing that most point to as a reason for all of of modern ailments.
21
Dear Jane. Can you please write about lipoprotein(a)? It is a significant risk factor for coronary artery disease and seems to be increasingly recognized in the cardiology community. I believe there is discussion about regular testing for LP(a) and a new drug is under development to lower it. Leslie Cho, MD, head of preventive cardiology at Cleveland Clinic, would be an excellent source of information. Many people have elevated LP(a) and don’t know it. In fact, most have never even heard of it!
4
The author says LDL lipids are heart damaging a couple of times and yet there is no evidence to support this. The author seems to buy in completely to the idea that LDL is an evil, damaging substance, so of course one should take statins. The body apparently uses LDL to repair damage to arteries, and this can lead to build up, which can be a problem, but I don't believe the mechanisms and causations have been fully worked out yet.
12
There is boatloads of evidence to support this. This is not a hypothesis, but the dominant understanding of the process of atherosclerosis. And not new.
https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.106.676890?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
2
@MD
What is the adaptive purpose of LDL particles? Do they only exist to give us heart disease?
LDL-C is a marker for future risk, but not a particularly good one. But hey, it sure has been profitable to medicate!
3
@MD -
Actually, we have refined our knowledge over the years. LDL isn't quite the bogeyman we once thought is was.
Take the time to update by watching the keynote address to the 2016 American Society for Preventive Cardiology’s Annual Congress at:
www.youtube.com/watch?v=j2DaqrKq6e0
You can skip ahead to 15:45 if you want, but best to watch the whole thing.
Our newer, better understanding explains the results of the long-term WHI Dietary Intervention randomized controlled trial and PREDIMED RCT (at 10:00). Otherwise, you can't. Watch it.
2
Choosing to focus on the benefits is hardly a scientific attitude.
10
Once again as you get into your late 70’s you don’t exist. At 82 I can no longer get a PSA test or a colonoscopy. Now I see I can no longer get a Cardiovascular Risk Assessment because it quits at age 79. I have nothing wrong with me, take no prescription drugs so I should easily live the 7 years that is predicted. But 7 years is also time for prostate or colon cancer to develop and kill me.
8
@Richard
In this case it's a good thing. You are a survivor! There just aren't enough data to do good risk equations well in older folks, and also there is "survivor bias," so enjoy your longevity!
2
@Richard: You can get anything you want, if you PAY FOR IT out of pocket.
But why would you WANT a screening colonoscopy at your age? it's somewhat invasive and uncomfortable and colon cancers are pretty slow growing -- if you picked a few polyp by the time they became cancers threatening your life….you'd be about 90.
If your concerns are serious -- my dad died of colon cancer at 78 -- talk to your gastroenterologist. If nothing else, you could claim "blood in your stool" -- whether true or not -- or abdominal pains -- then they would probably do a DIAGNOSTIC colonoscopy. It might cost you 20% of the procedure then.
You have nothing wrong with you, sir. Try to be happy.
4
I am allergic to sulfa drugs and can't take statins. People with this allergy should read the long list of ingredients in high blood pressure as well as high colesteral meds. Sometimes you will find a caution against using a specific one if you are allergic to sulfanilamide.
6
My wife is allergic to sulfa drugs and has been on 40 mg of Simvastatin plus BP meds for 20+ years with no issues.
Everyone is different, we cannot generalize, but it is good to watch out for unlisted adverse side-effects
The basics are pretty simple. If you have elevated cholesterol despite a Mediterranean diet and weight loss (and, it goes without saying, no smoking and regular exercise) then try a statin. If it gives you myalgia (muscle aches) then try another statin. If you find one that doesn't give side effects and lowers LDL cholesterol, stay with it. If you get side effects on all of them, then you're in a small unlucky minority. Otherwise, you're much better off.
If you have high cholesterol and you refuse to even try a statin because you *might* have side effects, then you shouldn't cross the street — after all, you you *might* get hit by a truck.
I say this as a physician who has had a heart attack and had a stent placed.
18
All statins are not created equal in terms of effectiveness or potential side effects. Simvistatin, for example, is known to have a higher incidence of cognitive issues than other statins. Simvistatin also has interactions with certain blood pressure medications that others do not. In my case it also caused severe GERD -like symptoms for 8 years. As soon as I switched to Pravastatin it went away completely.
I have high blood pressure, high cholesterol and triglycerides, am pre-diabetic and have a family history of early cardiovascular disease. So I have been highly motivated to find a way to continue to take statins.
8
@Brian Price
I took 20 mg simvastatin for > 20 years with no problems, but when I switched from 100 mg metoperol to carvedidol in November, I developed leg pains within 2 weeks. Stopped the simvastatin and they went away quickly, tried tit again and leg pains returned,
After 90 days, my LDL cholesteron went up 50 points.
Am now on 6.5 mg Lovastatin and the pains have not returned. Next blood test will see if the dose needs to be raised.
FYI, stopping the simvastatin had no effect on my stable 6.2 AiC.
What about using cholestyramine to lower cholesterol? It is used to bind bile but has cholesterol lowering effects. I took it after gall bladder removal when I had digestion issues and my cholesterol was significantly lowered. And I was only taking a half a packet 2 times a day instead of the recommended 1 packet 4x a day. Question regarding statins lowering the risk of blood clots - how does that work? Jane, can you please write an article about that? Woud cholestyramine help with that too? I ask after having a pulmonary embolism after a long plane ride.
4
@Sylvia Did you read the headline? "What about using cholestyramine" - that's what google or bing are for.
@Roger Google and Bing do not mention its use for lowering cholesterol, that is why I asked. Why so aggressive?
3
Like many commenters, I too have been fighting the high LDL/total cholesterol for many years through diet and exercise. Family history of heart disease; it did give me pause. Finally I relented to my naturopathic doc's advisement and am taking red yeast rice extract (Choleast) and a CoQ10 (UBQH by ITI). No side effects and my LDL has drastically improved. Hooray!
8
Red Yeast rice works because it contains lovastatin which is the first statin that was brought to market 30 years ago. If you prefer to take your statin in the form of a "natural" product more power to you. The problems with using it are: 1. The dose of lovastatin from different brands or even different batches varies quite a bit so you don't know what dose you are getting, 2. Manufacturers and practitioners who tell people to take it usually don't tell them the active ingredient is lovastatin so patients don't know to watch out for statin related side effects or drug interactions, and 3. It usually costs more than lovastatin pills which have been generic for at least 20 years and cost next to nothing. Some pharmacies actually give away generic statins for free.
10
The segment of this story most interesting to me is Jane's reference to a daily exercise regimen of walking, swimming and cycling. At 78 I find the increasing need for targeted strengthening exercises exceeds my capacity to do them as well as the other daily requirements of keeping house, cooking, doing laundry, gardening, etc. I simply do not have the energy to do it all and I resent having to spend so much time and energy just to keep the old body functioning. I can't imagine how Jane does three kinds of exercise daily and has anything left over to do the other have-to's of daily living, never mind having capacity for the things one enjoys. Extremely frustrating. As it is extremely frustrating to have to spend so much time strategizing about diet, exercise and medication. It's boring. Not what I am interested in focusing on. I'd give away years of life for body parts that simply work as they should without being a life work to maintain.
32
@Willow Luckily we are not required to do any exercises or make changes to diet. Mortality might find us sooner, though.
1
@Roger
True, Roger, but the issue isn't mortality so much as avoiding serious disability. Seems irresponsible to ignore the need for action when the price is so high for loved ones as well as oneself. On the other hand...I said it all in my response to Jane. Thank you for reading and replying.
@Willow Luckily we are not required to do any exercises or make changes to diet. Serious disability might find us sooner, though. : )
I found a hospital near me does calcium scans for $50. That's not the copay. That's the full price.
3
@JimLuckett I'm absolutely not a doctor, but was that a scan, or a scam - a low risk test that brought in $50, but may have been of dubious value. Most health insurance plans don't pay for coronary calcium scanning. The cost can range from about $100 to $400.
The following may be why most health plans don't cover it; perhaps the benefits don't out-weigh the cost?
A calcium scan is not helpful to patients who have a low or high risk of heart disease.
You could get a high score from the test even if your arteries do not have signs of heart disease. This could lead to other tests or treatments that you don't need.
Not all arteries that have early signs of heart disease have calcium. So you could get a low calcium score and still be at risk.
2
Not sure where Ms. Brody got the:
“In addition, in about 9 percent of patients, statins have been shown to raise the risk of developing Type 2 diabetes.”
No.
Does she mean, rather, that “Statins have been shown to raise the risk of developing Type 2 diabetes by 9 percent” in relative (or, less likely) in absolute) terms?
(Not “raise the risk” in 9% of patients, but CAUSE diabetes in 9%, or in 9% more, of patients.)
Moreover, her cite on the JUPITER trial “found 25% more cases of newly diagnosed diabetes in the statin group compared to placebo (270 vs. 216, out of 17,603 total),” not 9%.
While this is a large RELATIVE increase, 25%, it is not that large an ABSOLUTE increase, given the average simultaneous cardiovascular event benefit—IF the statins are ONLY given to those who really need them:
i.e. those with confirmed substantial calcium/plaque as evidenced by an inexpensive “calcium scan” coronary artery calcium score of greater than 100.
25% more diabetes, or even 9%, even if only in relative terms, IS a large amount if it is easily avoided. THAT is why it is important to figure out who actually benefits from statins, i.e. ONLY those with CAC scores of over about 100.
See my other comment for details.
11
Well,,, from reading the article, it appears that you can probably benefit from being on a statin. However, you cannot extrapolate your case to the population at large.
From what I can tell from the American Heart Association risk assessment, all males over 63 should be on statins. That does not make any sense at all to me. Apparently it does not make any sense to other researchers, either, as alternative risk calculators are being published.
There are many articles by non-US authors that question the Statins For Everyone culture in U.S. medicine. To me, those articles (many on the NIH website) make more scientific and statistical sense than the now widely discredited ACC/AHA risk assessment that basically has age as the only significant parameter.
There are numerous articles (www.ncbi.nlm.nih.gov/pmc/articles/PMC4513492/, for example) proposing that higher cholesterol is healthier and statins save no lives but cause higher all cause mortality.
The American College of Cardiology and American Heart Association have lost all credibility with me, and I no longer pay any attention at all to any advice from them. They have been floundering for years.
Now, there is a new study out saying DON'T EAT EGGS!!!
I hate to have to bring up that one of the healthiest populations in the world (Japan) eats more eggs than we do in the United States (an average of 320 per year).
23
@Bruce from Earth
You need to read the guidelines. They certainly don't recommend that all males over 63 should be on a statin. The presence of a higher risk doesn't result in a statin prescription. But it does mean one is in a group that benefits from statins. Then that needs to be personalized to one's specific risk features beyond the risk calculator, and perhaps a CAC score obtained to clarify the situation, if needed. These steps help a doctor understand whether an individual patient (within the larger benefit group) is more or less likely to benefit. In truth, the AHA and the ACC are among the few organizations out there driven by, you know, the science.
7
@MD Thank you for your perspective.
The ACC/AHA Risk Calculator predicts high risk for males over 63, no matter what other data in entered. My risk is over 10%. If I put the same data into the Australian risk calculator, I am low risk.
I was referred to a cardiologist, who listened to everything, including my ankles and said I have great circulation. Then he did the risk assessment inputting all my numbers, BP = 115/70, No diabetes, no smoking, HD Cholesterol = 55, LDL = 73, Total =154, etc. and decided I should be on atvorstatin.
That started me reading. I concluded that I would be CRAZY to take the risks associated with statins in exchange for maybe 1 or 2% chance of reducing cardiac risk.
These are NOT low risk medications.
I think you have to look at basic lifestyle parameters, and then look for data for that specific population segment, and not extrapolate Framingham data to predict high risk for everyone over 63. Lifestyle has changed a lot during the Framingham study years.
IMHO, if there were a scientific foundation, you would not have all these oppositional articles, some even from U.S. authors.
There is a lot of published disagreement whether statins save ANY lives. So, IMHO, StatinLove is 90% conjecture, 5% science, and 5% creative statistics, IMHO.
Apparently, I am not the only bad attitude out here, since I read that about half the primary prevention patients stop stains within two years.
Thank you again for your perspective.
8
@Bruce from Earth
Thanks for your perspective. This is really important, and there is no one size fits all.
The ACC/AHA calculator doesn't say whether something is high or low risk, it just predicts your probability. It is the data from the clinical trials that suggest that a 10-year risk over 7.5% is a group with net clinical benefit, considering the likelihood of benefiting from a statin vs the potential harm of myalgias, diabetes, or other side effects (if you think they are as important as having a stroke, heart attack, or dying - most don't think those are equally bad).
I agree that your MD should have been a little more thoughtful. I would have gotten a CAC score in you, and if it was 0, deferred any recommendation for any drug for at least 5 years.
About the Australia thing: The reason your risk is lower is that their calculator predicts 5-year risk and the ACC/AHA predicts 10-year risk -- so the Australian will always give you a number that is less than 50% of the US number... So you have to multiply the Australian risk by at least 2 (risk is not linear over time). And then there's the fact that the Australian equations are based on very old data from Framingham only, rather than more contemporary data from larger, more diverse samples in the US (like the ACC/AHA calculator).
Finally, if you rely on the internet for your views of statins you will not lack for anecdotes but you are likely to lack a balanced look at the science.
(continued)
1
When Do the Benefits of Statins Outweigh the Risks?
The answer is very simple:
when you have a Coronary Artery Calcium (CAC) score from a “calcium scan” of over about 100.
See the Central Illustration of the recent study PMID 30409567, “Impact of Statins on Cardiovascular Outcomes Following Coronary Artery Calcium Scoring,” J Am Coll Cardiol. 2018 Dec 25;72(25):3233-3242.
It breaks down the relevant benefits of statin on “MACE,” major adverse cardiovascular events, i.e. fatal and non-fatal heart attacks and strokes, over the next decade of those taking, and not-taking, statins, as a function of their calcium scores.
Find it at:
https://www.sciencedirect.com/science/article/pii/S0735109718386960?via%3Dihub#undfig1
If your doctor recommends statins—which you will need to take for the rest of your life (or at least until age 70 or so)—INSIST on a “calcium scan” first.
If you get a CAC score of zero (which is very common), then there is absolutely no reason to begin statins. All costs, with no benefits.
If you get a score of more than 100, then over the next decade daily statins will cut your risk of an event by ABOUT HALF!
That is a HUGE amount, both relatively AND absolutely.
Between 0 and 100 you probably want to “watchfully wait,” taking another calcium scan in another decade to see if you are beginning to accumulate significant plaque.
Please look at and understand these graphs. It is actually very simple.
10
@SRP
Basically right. The CAC score can be extremely helpful and this is what the new AHA/ACC guidelines recommend. But a CAC score is not for everyone, only those where it will make a difference in the decision (baseline 10-year risk ~5%-19.9%). If you are at lower risk, the yield of a high CAC score is low. If you are at >20% risk, even a CAC score of 0 means you are still at pretty high risk. So basically those in the middle range get the most info from a CAC score. But a couple caveats: 1) if you are already on a statin, don't repeat a CAC score, it will be uninterpretable; and 2) if you get a 0 and elect to defer statins, you may want to repeat it in ~5 years to make sure it is not changing.
4
@MD
Basically right. But a lifetime statin prescription should be based ONLY on a CAC score, NOT on cholesterol or LDL measurements. Or even on risk calculators.
Calcium scans today are very cheap.
And we are talking about, basically, lifetime prescriptions. And real side effects, including diabetes.
If you have high LDL but a CAC score of zero, then you get NO benefit from a decade of statins, only costs. (And that's a lot of people.)
If you have low LDL but a CAC over 100, you get, on average huge benefits from statins.
See the actual graphs noted previously.
Risk calculators are mostly about age. What matters is plaque (evidenced here by calcium).
And statins stabilize vulnerable plaque.
I agree that multiple calcium scans 5 or more years apart make no sense once you are more than 100, but lots of sense once you are in double digits.
4
@SRP
Well... Actually my comment was about the fact that CAC scores are useless once you are on a statin. Doing them more frequently than about every 3-5 years before going on a statin is not helpful because there is not enough time for meaningful change and it is unnecessary radiation. 100 is not a hard and fast number either -- it has to be placed into context of yoyur age, sex, and race. If you are 80, 100 is a low number on average and would imply a lower risk than average.
And I would disagree that statins should be withheld in people with very high LDL if their CAC score is 0 - plenty of people with familial hypercholesterolemia have their events with a CAC of 0, but this is a special group for sure.
2
Does this article and passionate comments not count as click-bait?
So many facts and counter-facts. So much time lost.
5
There is an error in your excellent article. The risk of developing diabetes is increased by 9% in the relative rate. In absolute terms 1 out of 255 patients treated with a statin would have a higher risk of diabetes, so 0.4%. This is from the JAMA meta-analysis.
So your sentence should read :
In about 0.4% of patients, statins have been shown to increase the risk of developingg diabetes.
8
Last fall I had a major stroke. My recovery is going just fine thanks. I take statins now along w a lot of other drugs.
I have no idea who this writer is but this is one of the most ill informed, narcissist articles I’ve read in years. The NYTimes is endangering the health and lives of its readers by printing nonsense like this.
6
I am always skeptical when relative percentages are used to show the reduced mortality from drug use. Despite not being a scientist I did check the cited study and found results showing a reduction from 20 to 17 and 24 to 20. I believe each number shown is a percent so reducing probability of mortality from 20% to 17% or 24% to 20% creates a different feeling about a decision to take a drug for me, which is why I do not like relative percentages. I know the article described larger percent drops than the 16-17% the numbers I saw offered, but my point is to ask that writers like Jane, please use real vs relative percentage changes. Big Pharma will milk the relative percentages plenty and 99.9% of patients - and, I suspect, a fair number of MDs - will run with the larger relative numbers.
8
Another issue which American forget to schedule, is a yearly Calcium scan. Most person do not want to pay out of pocket for it, and Medicare refuses to pay for it, this simple non invasive test provides you and your physician a picture of your arteries to see if they a clogged with calcium, which has relocated to your arteries instead of your bones.
4
@John Ramos
Yearly is too often. And once you are on statins, never would be about right.
4
@John Ramos
Yearly is useless - not enough time for meaningful change. Wasted $. And definitely do not do a CAC score after going on a statin -the test becomes meaningless then.
5
@JimLuckett -your choice
When I get my cholesterol tested I ask for the CRP test as well (C-Reactive Protein - measures presence of inflammation). I have high-ish cholesterol but have a low-risk CRP number. And, have been eating more oat bran recently and my cholesterol number was some lower than it has been in 20 years. Don't know if there is a connection.
Also, I have some acid reflux/gastritis. Some vegetables and lots of fruits have high acid content and it's sometimes advised to stay away from them when reflux gets bad. What's a girl to do????
5
@kbw you could try eating whole plant based foods and cut out meat and dairy and processed foods!
Why do articles such as this make no mention of dosage? I've been on 80mg a day now 10 mg a day. I suspect the risk of side effects is lower with lower dosage. 10mg is enough to keep the cholesterol in check, and I prefer the lowest effective dose.
14
Hello Jane, my comment is not about the value of statins. Your thoughts seem reasonable to me. But, that calculator seems not too useful. If you put in constant numbers and just change age, the risk varies dramatically. If you keep age constant and change LDL numbers the risk does not change much. Maybe that is what the data actually show but if so it means age is the biggest predictor of risk. It does seem sensitive to HDL and blood pressure measures. Have you researched the value of this or other calculators? It might be helpful to discuss the nature of the calculator.
6
@Joelle Presson Great comment. I just changed my age from 64 to 54 and dropped from my risk 10% to 3% (intermediate to low risk). I dropped my blood pressure from 125 to 115 and it dropped by 1%. Any "fountain of youth" drugs out there.
2
@Joelle Presson
Younger people should pay attention to and address risk factors like high cholesterol even when calculated 10- year risk is low; damage is cumulative and for them, lifetime risk is much higher than ten-year risk.
1
@childofsol
Exactly right childofdsol
And yes, folks, age is a really important predictor of cardiovascular disease, because it integrates the cumulative exposure to the risk factors over your lifespan. You can't magically change your age in life, and it doesn't work in the risk score either. When you magically change the age value, of course you get a different risk estimate - you are not estimating the risk of the same person, but now a different person with a different cumulative exposure to risk factors.
1
The reality is that the treatment of high cholesterol and high blood pressure with medications has improved our quality of life and increased the human life span significantly. The person who distrusts modern medicine will die prematurely and so be it - that’s their choice. My dad refused cholesterol meds into his 70’s and eventually ended up with 90% blockage and 4 stents. Now he’s a believer! In 1946 the average life span was until the late 60’s. I plan to be around a lot longer with a healthy lifestyle and the help of modern Western medicine!
7
As a 65 year old physician I find that I rarely agree with Ms Brody but she makes the valid point that there are people with excellent diet/lifestyle but with very bad lipid profiles. These people will usually benefit from a statin with acceptable or no side effects. Not always, usually.
That said, please, please, please don't get your health care advice from the NYT or, even worse, the comments (me included). Educate yourself without confirmation bias (hard to do) and ally yourself with a healthcare provider who will listen to your concerns and work with you (even harder). I've personally found that well trained PA's and CNP's often excel at this, (heresy).
19
@James
This is good advice, especially with regards to NYT comments dealing with personal health. I usually just stay away from the comments to health articles as they are mostly anecdotal and nearly always 100% confident in their conclusions, which just shows how biased they are.
Trying to understand complex things is good, but falling for rock steady conclusions based on incomplete information is not.
4
@James.
As a 68 year old heart patient/ 4 stents/ CAD/ 40 mg 1X day of Crestor plus a beta blocker , a diuretic and Plavix all daily - I agree with you 100 %. These articles do a great disservice to cardiac patients!!! Find a good cardiologist who you trust and let the doctor do their job!!
The Times should rethink these misinformation forums . The stakes are high and the consequences deadly for heart patients. They don’t call heart disease the silent killer without good reason.
1
@James Great advice and luck to those that follow your excellent thesis.
Nice to see the Times still working PR for Big Pharma. The vast majority of people with elevated cholesterol WILL lower it with diet changes alone. Statins are a crutch for those who choose to not give up, or at least minimize, the cholesterol and fat laden foods that we have become accustomed to in the modern Western diet. There is absolutely no dietary requirement for cholesterol and the amount of fat that the human body requires to thrive is less than 10% of total caloric intake. Get the cholesterol off your plate, and trim the fat to ~10-15% and your cholesterol plummets. But there is no profit in that. So unAmerican.
4
@arusso. Diet didn't work for me. Statins do. End of story.
12
@arusso- I often recommend pts try to lower their cholesterol with diet and lifestyle changes prior to the use of statins as I want them to see the futility and value of taking a statin which work- I would point out, the one food we all agree should be limited is beef. It comes from cattle who are VEGETARIANS- most of our cholesterol is what our liver makes and statins can limit its production.
While there will be around 600 thousand cardiovascular each yr reducing the modifiable risk factors - lowering bp, quitting tobacco, controlling diabetes can reduce the risk- age and family history are risk factors that are not particularly modifiable.
As for ct ca scans they may detect the calcium in the arteries AFTER the damage has been done- prevention is key-
SOOOO-Change your lifestyle, quit tobacco, control your bp and glucose and taking your statin remains your best chance to reduce your risk of heart attack and stroke from cholesterol deposition
By the way- in 30yrs of prescribing statins (while it is reported ) I did not see a single pt die from complications of statins(though some required reduced doses and of course monitoring is important). I did on the other hand see many pts who refused to modify their risk factors suffer heart attacks and stroke. Heart disease is multifactorial- cholesterol reduction and smoking cessation are critical in reducing that risk. Remember a heart attack can cost you your life and 10's of 1000's of $. You owe your family more!
11
@arusso . You really shouldn't shame people by calling statins a crutch. My spouse and I are in our 70's. My cholesterol is a little too high; his is dangerously high. We already ate very healthily, but decided to follow the guidelines in Cholesterol Down and adhere to a strictly plant-based diet. My numbers are now excellent. His numbers improved a lot, but not nearly enough. We've taken no medications up, but he will now try the lowest dose of a statin. Yes, we must be wary of "Big Pharma" but also must appreciate the life-saving benefits of intelligently taking advantage of modern medicine when appropriate.
7
Ten years ago, my mother's GP, not as attentive or caring a practitioner as those commenting on this article, prescribed statins , despite no heart disease or strong family history and only borderline high cholesterol levels, likely due to an increase in her weight. When she started to experience muscle pain and spasms, rather than investigate the nature/severity of the pain, the doc continued her on the statin and simply prescribed pain killers. Within six months, she was unable to walk, hospitalized with rhabdomyolysis and spent weeks in rehab. Shortly afterwards, she was also diagnosed with myelodysplastic syndrome. I cannot say for certain if there is a connection between her use of statins and the downward spiral that ultimately took her from us, but I strongly feel that her experience is not atypical. Neither Jane's previous article or this one mentioned what can be dangerous side effects of this drug for some people- much more serious than muscle pain and the statin fog. Many patients, for reasons of access, education, age, language facility, etc, lack the wherewithal to ask questions, to understand the ramifications of their health conditions and what is being prescribed for them. Many practitioners, for a whole host of reasons, including biases about their patients, don't bother to look for the least harmful alternatives, rather than the quick fix. No doubt that statins work for many people, but based on my family's experience, I would never take them
16
My case--Simvastatin had a decent effect on blood lipids, but caused muscle pain. Pravastatin, weak effect on blood lipids, leg pain. Generic Crestor, tremendous effect on blood lipids, no pain at all. Almost all of my blood lipd levels are now near optimum, with the exception of Lipoprotein (a), which runs in my family and is not helped by statins. I was high-end pre-diabetic with A1C of 6.4, going low carb totally eliminated that--running A1C of 5.4 now. I now have a stent in one of my coronary arteries, I wish I had found the Crestor and low carb sooner.
3
Thank you, Jane, your column is much appreciated and apropos to this reader. The nickname I use for myself is "Nature Girl." I eschew all drugs, had two children with no meds at all, and you can't find so much as an aspirin in my house. I am not going to be a dupe of Big Pharma, no, not me! So for about 4 years I tried to address my elevated HBP through "life-style" changes -- weight loss, exercise, limit alcohol, no smoking (never did), better food choices. But then there's the fact that my mother died of a massive stoke at age 62 (I am 69), and you can't change your genetics, at least not yet. About a month ago I had an epiphany and committed to a drug regimen, remaining highly skeptical on the subject of side-effects. I am stunned at how quickly my BP dropped with no side-effects. With apologies to Wm. Shakespeare "the fault, dear friends, may not lie in your life-style but in your genes, that you are human."
8
I am a doc. I hate to prescribe statins although I do and I must. I get an NMR lipid profile in my patients. I take a meticulous dietary history. I make sure they don't have pre diabetes or diabetes. I look for a family history of diabetes and coronary artery disease and I look for drug use, smoking and hormone use in my patients. I also get a CRP level, a baseline CPK a muscle enzyme that statins can elevate and baseline liver function tests. In my smokers who won't quit or can't quit and in my diabetic patients and in my patients where the CRP is high or where the small dense cholesterol is high or the LDL size is B or the LDL particle number is high and the HDL particles are low and those patients with co morbidities such as sedentary habits from disabilities or those who are confirmed couch potatoes, obese patients with a high body mass index, South Asians who by the MASALA Study are high risks, Hispanics and black patients also high risks, poor and obese patients who live in food deserts or who live on fast foods because of cost of fresh produce or habituation, those who've already had a heart attack or stroke, those whose Apolipolipoprotein B and Lp(a) levels are high, those who have genetic hyperlipidemia and or high triglycerides or NASH, kidney failure or dialysis patients, those on targeted chemo that can raise cholesterol levels, older Transgender patients on hormones and hypertensive patients need statins as life savers--that's a lot of folks, folks.
11
I have been on statins for the last 14 years and have never experienced any of the side effects mentioned here and my cholesterol is below 200 and that is a good thing.
6
@gpickard
You appear on this board like good cheer in the midst of dark negativity.
1
That's great for you. However, there are those of us who take statins and get debilitating myalgia, even on super low doses.
6
@MJG When I first began statins I had muscle pain-legs. Now I take 200mg CoQ10 am and pm and no muscle discomfort or weakness. They all deplete CoQ10 at the cellular level.
Of course a drug that messes with liver function and saps CoQ10 from muscles has side effects that some will find intolerable.
Those who experience those side effects will not be able to take part in the great statin experiment. Doctors need to acknowledge this and not keep forcing such people to continue taking the drugs, thus degrading their quality of life for possibly marginal longevity benefit.
If you don't have side effects from statins and believe your risk factors justify taking them, statins might be right for you.
Speaking for myself, I am adverse to taking drugs; an initial experiment with statins led to awful constipation. While it appears I inherited a liver that makes high total cholesterol from a paternal line suffering from heart disease (no matter my diet), I inherited mitigating factors (high HDL, large fluffy particles, etc.) from my mother's side. Calcium cardio scan did not show high risk.
As one elite cardiologist told me: "We really don't know what these numbers mean." She prescribes statins only after heart attack.
No statins for me, thanks. I like my liver function the way it is.
6
For many, the benefits of statins outweigh the risks, but for some of us they do not. I chose to not take statins after muscle spasms (which stopped promptly when I stopped statins), niacin after horrific flushing and sweats and other medications that did not lower my cholesterol. No doubt I too make too much cholesterol since I eat very little meat and eat no full-fat dairy and yet my cholesterol is usually above 250, with an LDL around 170.
Being only a few years younger than Ms. Brody and a former medical social worker, I am not at risk of a premature heart attack--in fact, my heart appears to be fine.
I look forward to the day that a pill arrives to help lower my cholesterol without side effects, but until then, I will do my best to exercise and maintain my Mediterranean type diet. These seem to work best for me.
3
Let's not so readily dismiss reports of statin-related muscle pain, which may be a sign of actual muscle destruction (often dark urine is a tell tale early sign, but there are also lab tests which can be done) nor of the statin-related onset of diabetes. Nor should one ignore that women may react differently than men to statins, which is well documented by impressively large studies (http://www.cwhn.ca/en/node/39417).
People are not the same and their reports of negative reactions should not be tossed aside cavalierly as unworthy of credence.
For myself, I developed diabetes and muscle destruction when placed on a statin. The muscle pain persisted no matter which statin was tried and strikes even with the weakest natural statin, a non-prescription red rice pill.
Just saying, there are individual variations in reactions and not all are positive.
15
Why do you never focus on the down side of statins? I have tried all of them and cannot tolerate them. They gave me muscle aches, brain fog, and eventually aphasia, which made my doctor take me off them. 99 out of 100 pieces I read about statins are about how helpful they are. What about those who are suffering and cannot tolerate them?
9
Ms. Brody: May want to listen to this STEM talk if you have not already done so. May cause you to moderate and/or qualify some of your comments on LDLs and risk.
https://www.youtube.com/watch?v=DpZIXWpN1og
If you are having problems with statins, try Proluent. I got to the point were I could not walk even short distances with statins. I started Proluent, I had great results with no side effects.
I have been seeing cardiologists for over 20 years. If you want to know about problems with statins, go to any cardiologists waiting room and simply say, "Any body here taking statins?" I think you will find large numbers of patients have trouble with those meds.
4
Very thoughtful and well said-From a busy cardioligist
2
You didn’t have to go to Stuyvesant, Madison povidrd a great education, wasn’t George Kapp one of your teachers? Superb article ... sadly too many rely on modern day witch doctory
I read recently that there is now an alternative med v statins. Begins with a B.
LDLs too high? Long term Crestor muscle aches? RAPATHA is the gift ... LDL 130 - three months later LDL 17. Get off the niaspan, fenofibrate - 3 months later LDL - 35. TOTAL CHOLESEROL 170-185 down to 125. expensive so you need to document stating side effects but worth the effort...this
Statins can be very helpful and not just lowering Cholesterol but it has a strong anti inflammatory effect. Atherosclerosis is an inflammatory disease, its more then just cholesterol. See letswakeupfolks.blogspot.com- the blog , heart disease and stroke and atherosclerosis for a complete discussion.
1
LDL must be oxidized to be harmful. Read what Fred Kummerow had to say about cholesterol.
Thanks Jane for your follow-up on Statins. Obviously, each of us reacts differently to statins for different reasons.
My wife had a single coronary bypass at age 55 after hiking in Greece for a month and experiencing chest pain. She went on Lipitor for about eight years but experienced progressive muscle pain. She tried alternatives such as a plant based diet, red yeast capsules, etc, but her muscle pain increased to the point she called it quits on statins but continued the plant based diet.
I had a heart event at age 72 and had a single metal stent. Over the years I have tried statins, first with Lipitor. Eventually after two-three years, I also had intense muscle pain and quit taking statins. I did lower my Cholesterol to 180 with a plant based diet and exercise. The magic marker seems to 150.
After talking to my physician daughter, she recommended Pravastatin, one of the weakest and oldest statins on the market. I have been on it for several years increasing dosage from 20mg to 40 mg without any negative effects and my Cholesterol reading usually varies from 120-140.
Now at ages 80 and 82, we are still very active and work out daily, eat a Mediterranean diet (plant based with some chicken or pork occasionally), and hike, bike, and kayak.
So...in short, I found it's important to have a plant based diet and try several statins to see which one works without muscle pain.
15
Statins crippled me. Knee and joint pain that persisted and loss of muscle mass. I know others have taken them without side effects, but not me. And I tried them three times.
I lowered my cholesterol from 220 to 180 by diet and exercise. I will never take them again.
7
The entire discussion of statins and side effects is still secondary to the real question that is yet to be answered: is the lipid hypothesis accurate?
From the National Institutes of Health:
"The lipid hypothesis has dominated cardiovascular research and prevention for almost half a century although the number of contradictory studies may exceed those that are supportive. The harmful influence of a campaign that ignores much of the science extends to medical research, health care, food production and human life. There is an urgent need to draw attention to the most striking contradictions, many of which may be unknown to most doctors and researchers."
6
The decision process we use to decide whether to take a drug or not needs to be studied. A lot of people’s opinions about drugs comes from Google searches and hearsay from health blogs; our choices are value laden, based on coffee room gossip and not science based, doctor driven. How is one to sanely use the side-effects charts that come with each drug? Are they not so frightening no sane person would ever swallow the medicine?
My doctor at the University of Utah told me it is a joke among doctors that if aspirin just come on the market today it would be one of the most controversial drugs ever and have to go through a lengthy FDA approval process. Doctors joke that aspirin, a true miracle drug, would have a fight to be approved.
Finally, i think we Americans are a pampered people. We expect everything, including drugs in our blood streams, to work perfectly and when they don’t we cry out like spoiled children. My bottom line: find a doctor you trust, then trust her. If she says Lipitor is what I need not to die of cardiovascular disease, then I take it.
8
@Dave Thomas
Aspirin is considered a relatively dangerous drug now. It is not recommended for primary prevention of coronary artery disease except in diabetics and even then for use with an abundance of caution, the risk of bleeding outweighing the benefits of anticoagulation.
1
@Dave Thomas Your doctor flatly said this would keep you from dying from cardiovascular disease? Not decrease risk of...or anything? That is surprising.
2
@Usha Srinivasan aspirin and eggs! what next?
My husband and I have both had great success lowering all the bad cholesterol numbers (mid-200s down to low 100s for the overall number) and raising the good numbers with the natural statin, red yeast rice, plus niacin. No side effects and no support for big pharma. My doctor even told me that big pharma has worked to limit or restrict the level of active ingredient in red yeast rice supplements because they are so effective.
@Kelley My husband and mother had great success with just increasing soluble fiber -- taking 6-10 Metamucil a day as well as flaxseed oil. My mother's LDL decreased so much after 6 months of this regimen that her doctor was completely flabbergasted. She had recommended statins to my mother, but then changed course after seeing how much my mother was able to decrease her LDL through taking fiber supplements.
8
@Ali
And I am doing the same. What I hate is the 9% diabetes stat. It is not a comforting stat.
3
Statins might be right for Jane (familial high cholesterol, diet and exercise don't solve the problem). For me -- guy with high cholesterol but no history of heart problems -- they're not, even though my doctor and health insurer pushed them. My own research, presented as a chapter in my book Ten Drugs, convinced me that statins, while often useful, are also, in general, overhyped, overprescribed, and oversold.
4
@Tom Hager I once interviewed a cardiologist for a WebMD story who said statins should be put in the water supply like fluoride...and I thought, whoa.
3
everyone will react differently depending on their genetic and chemical profile and by their lifestyle (weight, actibity, and emotional). so i dont understand why people dont just see whst works for themselves and stop complaining about what other people do.
the probkem with the US healthcare system is the cost and complicated insurance market, not the drugs.
2
I’ve been nagged and nagged by my doctors to get on statins. The first time I tried, I had severe global muscular pains. The second time, within 4 days I became suicidally depressed. I stopped taking Lipitor and my depression lifted immediately. If I kill myself, how can the statins benefit me?
5
@Annie Eliot Ditto! Recently, I was determined to follow my doctor's advice (not the first) and I tried Lipitor (after an unsuccessful attempt with Simvastatin). I am 59, I go to the gym every day, I know my body well. Within 3 weeks of starting Lipitor, I could not finish my most basic gym routine. So finally I tried walking which is the most pleasurable of all activities but felt overriding persistent pain. I quit the drug that day. Just now I took the Cardiovascular test cited in Jane's article and my risk is 1.8%! So why are doctors so determined to get me on this drug?
4
@Annie Eliot Try taking Metamucil and flaxseed oil daily. It has worked for a number of people I know who were recommended statins but did not want to take them. My mother achieved a big reduction in LDL after being on this regimen for 6 months.
3
@Nancy
They'll say to prevent renal failure from renal artery stenosis, strokes from carotid occlusion, Alzheimers from tangles and plaques of amyloid and dementia from cerebral small vessel disease and even osteoporosis that has been linked to high cholesterol levels.
1
My LDL, i.e. Bad Cholesterol, has always been high, if not astronomically high, but my HDL, "good cholesterol," is also very high and triglycerides are low. I always argue if my "Good Cholesterol" was "normal," my total cholesterol would be below 200. As it is it is 230. In any case, a few years ago I began taking Red Yeast Rice, just two capsules, and a COQU10, per day. This has kept my cholesterol in the same range it was more than ten years ago. Red Yeast Rice is what Lovostatin is made of, and that, an old cheap Statin, is what I would go for if my Bad goes up. If you do go for Red Yeast Rice you have to get a very good one, a pure one. For awhile I sacrificed ALL Saturated Fat and Cholesterol containing foods. Yes, my total went down but not enough to make it worth it. I still eat very little cheese, very small portions of meat, (no, or very rarely, beef), but butter? I cook and bake with it sometimes now. Truthfully, the way things are going in the world I'm not anxious to live to be 100.
14
@Vicki lindner
Ironically you may be the very one to hobble to 100 while those on Lipitor die early. I myself think, easy manners, humor and laughter and reduction in stress with a pure pleasure in nature and leisure is what gives one a long life of quality. Most people cannot afford my prescription in the USA and also when you are between 10 to 50 years it is easier to not want a long life to eighty rather than when you are between 50 to 70 years.
3
I dug into the data on statins and came to the conclusion that it HELPS those whom have already have had a heart attack and that the science of cholesterol being the cause of heart attacks was at best somewhat shoddy. I even showed me partner that's a pharmacist and he agreed the the data wasn't incredibly strong in those that haven't had a stroke or heart attack so the prevention science is a bit off and I won't take a statin. There's talk amongst scientists that what's more important is whole body inflammation and C Reactive Protein levels. If we were to think statins are a miracle drug we should have seen a massive reduction in heart attacks which we have not. If you don't live a healthy lifestyle have a strong family history of heart disease then yes you should probably take them. Until the data is stronger the benefit is not worth the risk. However in such a litigious society a doctor recommending you not to take them comes at great risk. I defer to scientists and researchers these days more than MDs. They are far behind reading the latest research and how could they have time they're worked to death.
6
Jane, please consider the question of proper dosage in your next go at statins. My layman's impression is that doctors prescribe larger dosages than are necessary to bring down cholesterol. I have found that smaller dosages work nearly as well to reduce my previously high cholesterol as the more problematic large dosages. I'd say 40 mg daily is pretty high. I take 10 mg and find it works without noticeable side effects. The individual, working with a doctor, can measure cause and effect and choose the right prescription.
3
@Jim Good point. often the dose is way high, Each of us has an individual response. I suggest start low and work up as needed.
@Jim
Just a note... the dosage differs for each statin. 10mg for one may be nothing for another. So, it is mportant to know the nature, dosage reasoning for each differing statin.
6
@Vicki. True. I was referring to Atorvastatin, which I believe is the generic Lipitor.
1
I have been on a certain statin since January of 2014 with no ill effects (and good numbers). Last November my medical provider said they would no longer pay for ANY of it, and I would have to choose a generic statin or pay upwards of $200 per month. There was only one statin left that I had not tried prior to starting the one I have been on since 2014. I should add I am in great shape physically but I have a genetic heart problem. I tried the generic, took one pill every other day for 7 days, and by the 5th day had such horrible pain in my left hip it was difficult to pivot, get out of bed....I felt as if i would be unable to do much soon if I stayed on it. The insurance/pharma provider finally gave in with a letter from my cardiologist. It took about two weeks to feel like myself again. I kid you not, the pain was awful - there are differences between statins. Make sure you stand up for yourself!
15
If I were a farmer with a statistically large number of animals , and my animals all exhibited high cholesterol, with statistically proven risk that there numbers might diminish drastically because of the cholesterol levels, I would use the statistics available and treat the ENTIRE stock. And I would probably see benefits in reduced mortality. Of course I wouldn't worry too much whether the animals have nightmares, forget where to look for food, feel generally downbeat, or have muscular pain. All that mattered would be how many of them survive. Population statistics has its purpose, but is of questionable use in establishing treatment regimens for individuals.
8
@Ronald Weinstein Brilliant analogy to the way drug studies are often interpreted. An inability to pinpoint the exact individuals who might benefit, leads to the recommendation to treat the entire population who is considered at risk. But as all things medical, the " art " of medicine is trying to individualize the care for the most optimal result in the particular individual in question.
5
I took the CV Risk Calculator and scored 22%.....high risk. Out of curiosity I changed my age from 76 to 56 and my score was 4%, very low risk. So apparently the biggest risk to having a heart attack is growing old. Who knew?
51
I suppose like most things in life, the older the heart is, the less well it functions
1
I have been on atorvastatin for six years since my MI and have thankfully had no side effects. Call me crazy, but I trust the cardiologists at Kaiser implicitly.
2
@jimi99 Doesn't mean you wouldn't have felt the same or better without them or that you will live longer. The bottom line is: you'll never know if they helped or not.
2
@Ronald Weinstein
Yes, we’re sll an experiment of one...
Some have mentioned the muscle ache side effects of statins, but I haven't yet read any mention of the mental side effects of statins.
I was prescribed statins and within five days had extreme mental fogginess & hearing issues. I couldn't remember the name of the drug anymore to look up further side effects online and had to keep the box next to the computer. My dog's constant concerned barking seemed far away.
My online research found more info on the mental side effects of statins. They're often hushed up. But a lot of people suffer them. The worst cases feel these negative effects right away like I did.
I stopped taking the drug immediately and will NEVER touch it again. I'd rather a heart attack or a stroke. Sometimes the cure IS worse than the disease.
19
@Mary Anne Gruen You're not the only one having side effects from statins. The author, possibly impaired by the use of the statins, clearly states she prefers to focus only on the benefits.
11
@Mary Anne Gruen
My sister had to quit for that reason. At first I thought she was just having a psychological moment since she did not really want to take them, but her physician had frightened her about the potential long term consequences. After about a year, I thought she was headed for dementia. Low and behold, came off the statins and her fog cleared. I would never have believed this was possible with the drug had I not witnessed it myself. I thought it was hysteria or emotional illness. Call me convinced. I do know it is not a problem for everyone since others I know seem not to be affected in this way.
5
In addition to near crippling tightness in some muscles, I have also incurred cloudy judgment and memory loss, accoirding to my wife.
4
As an Internist for over 40 years, I saw the development of therapy for atherosclerosis- (heart disease and stroke) in my patients. The medical profession went from only treating the after effects of cholesterol deposition in the arteries, acute heart attack, stroke and death (in up to 1/3 of patients with the first heart attack) to aggressive prevention with statins, other medications, diet exercise and lifestyle changes.
The science supports the success of these various modalities.
Lower the LDL cholesterol reduce the incidence of cardiovascular events.
I first became aware of the dramatic success of this approach while at a hospital reception for physicians and vascular surgeons. I was reminded that since the institution of statin therapy I was not having to refer as many patients for bypass or carotid surgical repair. Why? Most of my patients were taking statins, many were quitting tobacco and trying to have a better healthier lifestyle(i might note they tried prior to statins as well).
Yes some patients have difficulty with statins, but in my experience, most people CAN take them(adjusting dose) and take them with an anticipated SAFE reduction in heart attack and stroke risk.
Very few patients had serious adverse effects and for the majority none at all. It takes large numbers to be sure of these benefits and the safety, but it appears to be born out that the results of lowering the LDL by whatever means is beneficial to the patient and to the healthcare system.
23
@Dr Joseph Cecil would like to get your opinion on the alternative view that atherosclerosis starts with vitamin deficiency causing increased gaps between endothelial cells and the structural impairment of the connective tissue in the artery walls. Thanks.
@Thomas Molitor
No valid scientific evidence for this at all - other than perhaps Vit D or C deficiencies. In our country such are very unusual, unless there is a very strange diet or medical condition (especially the former).
1
What are your thoughts and any experience you’ve had with the efficacy of the natural statin, red yeast rice, combined with niacin?
2
Discussion of this issue might benefit from inclusion of the new studies about different shapes of cholesterol molecules. This finally helped explain why all the women in my family have sky-high, medication and diet resistant cholesterol scores yet consistently have no plaque per angiograms. For people who don't have "sticky" cholesterol, there's no real reason to worry about lowering cholesterol numbers.
10
@Working Mama I have tried in vain to figure out how to get the test that determines whether one has big fluffy or small size cholesterol molecules. If anyone knows what it is called or how to get it, please post!
2
@Nancy Cardio IQ test from Quest Labs.
Code number is either 92145 or 92500.
(I have seen both and haven't gotten the test yet)
This is an advanced lipid profile.
I started on a low dose statin 8 years ago. My cholesterol went down as did LDLs from a borderline level to acceptable range. However, over 4 years of taking them I had unusual leg pains at night. So much so, that I tossed and turned and kept waking up. I did not make the connection to the statins, thinking it was my mattress or my weight, activities done during the day etc. I discussed this with my doctor and I stopped taking the statins for 30 days. The leg pains stopped entirely. Still, I was worried about my cholesterol levels. I now take the statins every other day, in the mornings, and I take them with the CQ-10 100 mg pill said to ameliorate the muscle issues. My levels are down- not perfect- but down from the borderline range. I still get the muscle aches at night, but much milder. The alternate night without the statin makes up for the achy night. This is my bargain with the devil. I can't face a life with no sleep just to bring down my cholesterol levels to some decreed "safe" level.
8
@Gerry Atrick
Such a condition is very common, and has nothing to do with statins. They have a different distribution and are of a different type of muscle pain.
@Gerry Atrick CQ-10 100mgs as sold by vitamin makers and their ilk have demonstrated a very reduced uptake of CQ-10 as it gets destroyed, for lack of a better term by the digestive system. The only from to take it orally, which by passes this, is from research done at Otago University in New Zealand several years ago. Check out a product called MitoQ-10. It is 'expensive', but it provides CQ-10 way more effectively than other forms.
4
@Bob His went away when he stopped the statins. Then came back, milder, with the changed regimen. What does that say?
4
My cholesterol levels have always been in the normal range, but a routine x-ray of my lower back revealed arterial plaques, and a subsequent coronary calcium scan showed major blockage in my descending aorta. I now take an aspirin and a statin (provastatin) as well as blood pressure medication, as I have had high blood pressure. At 76, I've never experienced any symptoms relating to heart disease. I speculate that my years of running created corollary circulation around the blockage.
1
Your article is very timely for me. I just turned 50. My cholesterol and LDL measures have historically been similar to yours (240s and 140s, respectively), despite my healthy lifestyle and diet. A year ago, my doctor and I started the discussion on statins. We covered all the pros and cons of your article. He prescribed a daily dose of 10 mg. After a month, my cholesterol and LDL we’re back in territory. But I developed aches in my upper back, neck, and left arm that I thought was attributable to a pinched nerve. The aches made running more than one mile impossible. The aches made lying flat and still for the MRI scan (to diagnose the pinched nerve) also impossible without prescription pain meds. My doctor recognized the connection (i.e., it wasn’t the pinched nerve) and told to stop taking the statins. Problem solved. Fast forward six months, my cholesterol and LDL we’re back in unhealthy territory. I resumed taking statins. But this time, my dosage is down to 5 mg. I’ve been on that dose for a few months now. No muscle aches! My cholesterol level is in the 180s, LDL is below 100. Glucose is a bit higher than before, which I’ll have to keep an eye on. All in all, statins work for me.
5
@Warren Li
Your experience is quite typical. If you need a statin, tehre is very likely to be a drug and dose that will work for you, if the first one doesn't.
Been taking statins for years. Although I ate well and exercised my body was over-producing cholesterol. No side effects, no issues - just the lowest levels of cholesterol I have had since my 30s. We are all different. One size never will fit all.
5
A year ago, my doctor told me my cholesterol at 204 was 2 high and gave me 2 options. Take statins or become vegan.
I tried one statin, and had immediate pains in muscles so i decided to become vegan. In a year since then, my cholesterol is now 168. I am 79 so the choice to be vegan and change my diet took some work . I also upped my exercise to 6 days a week at a gym or outdoors weather permitting.
12
Good for you, out of all these responses you took the route everyone should be taking. No one will have high cholesterol or heart disease with a whole food plant based diet, especially no oil. It happens to be quite easy if you know your health depends on it. Instead people are ok taking statins and continue to eat meat, eggs, dairy and consume all oils.
Congrats
4
@Cindy
Any "plant-based diet" that claims to prevent or reverse any disease always involves removal of _sugar_, refined carbs, and refined seed oils.
Yet the benefits are attributed to the vegan religious fervor, while ignoring the sugary elephant in the middle of the room.
8
@Cindy
The idea that nobody who eats a whole food plant diet has cholesterol problems is incorrect. Some people, such as Brody, have cholesterol problems because their bodies produce cholesterol regardless of food intake. It is a gene issue that cannot be overcome by diet.
5
Ms. Brody's column has a huge scientific assumption: cholesterol causes cardiovascular disease.
As I understand, there is no conclusive clinical trial (unsponsored research, that is) linking high LDL levels with heart attacks. People with low LDL get heart attacks and people with high LDL don't get heart attacks
Today, the conventional thinking about high cholesterol levels as the primary origin of human cardiovascular disease is being challenged. The statin industry is a $40 billion global business. Big Pharma is a major source of advertising revenue for mainstream media publishers such as the NYT.
In sum, I urge readers to read up on the controversy of whether cholesterol is the primary cause of atherosclerosis. There's an excellent book I just finished by Dr. Matthias Rath called "Why Animals Don't Get Heart Attacks But People Do." His main assertion is heart attacks and strokes are the result of long-term vitamin deficiencies (disclosure: I'm not a vitamin salesman).
Go on Amazon and you'll find many books available that refute Ms. Brody's assumptions. She cherry-picks research to support her argument. But one can just as easily cherry-pick contrary research.
In the end, whether to go on statins or not if you have high cholesterol levels is a personal choice. You are your best doctor. Spend some time reading more sources than his column and I think you'll be a much more informed to make your personal decision.
19
@Thomas Molitor...."In sum, I urge readers to read up on the controversy of whether cholesterol is the primary cause of atherosclerosis."....Whether cholesterol is the primary cause of atherosclerosis is immaterial. What studies have shown is that when people with high cholesterol levels take statins the number of heart attacks is significantly reduced. And that is not controversial.
11
@W.A. Spitzer Please link to the study you are citing, thanks.
3
Once again, Ms. Brody is decades behind on the science. I agree with her that statins are valuable, if they are well tolerated. But really, Jane, after all of these years: claiming that saturated fat is a factor in the production of cholesterol when all of those old 1960's and 1970's studies have been throughly debunked, plus research showing that dietary fat produces insignificant increases in cholesterol---and Jane the rabbit experiment that fat produces cholesterol folks like to cite in which rabbits were fed high fat diets and then their cholesterol skyrocketed was, after all, done on a species of herbivores---to say nothing of new research now being done into the mechanisms of CVD as an immune/inflammatory disorder. Wake up! It's 2019!
34
thamk you for this article. my history is similar to yours; i was first disgnosed with high cholesterol in the 80's, and I had no idea what it was! i lived on oat bran, broccoli, and boiled chicken for over a month, and when I was re-tested, my cholesterol had gone up 30 points! i have been on statins ever since, and have gotten to very good cholesterol levels. with the help of related drugs, even my triglycerides are in a healthy range. I have tried various statins to find the one that works best for me--this is not one-size fits all. i have regular blood tests, and have been fortunate not to have any negative side effects. i wish everyone the same good results!
3
Your numbers seem quite healthy to me in comparison to my husbands. He cannot get an ordinary test done, he has to get a special report to figure out quantities of all the usual suspects in his lipid profile. His triglycerides can rise above thousand, ugly vldl, low hdl. Cholesterol is the least of his problems. He took Lipitor for years, developed necrotic, purple boils all over his body called Pleva. We stopped Lipitor and it has taken a couple of years for it to go down. No medication or antibiotics for it. He takes Lovaza, a prescription fish oil, with a price enough to give one heart problems. His numbers are ugly with all his healthy habits. His Ca score, fine. I confess out of love for the man I make a homemade medicine, roast, grind etc. so I can be sure of what is in it and make him take it daily.....who knows if it works, but I feel I too need to contribute to his well being. And his numbers look sort of like yours now. In my books, that looks healthy.
One thing I have found is the idea of eating healthy, especially amongst busy folks, consists of salad and readymade health foods. I think everyday eating needs to be rethought. The balance of nutrients, in your daily eating, outweighs simple calorific intake. It is certainly a beginning, but to remain healthy through food...it takes a lot of effort. It’s possible, but not simple. Hence the option to take magic bullets ignoring the side effects that may pop up not today or tomorrow, but years from now.
3
My tests usually come in between 240-270, yet I as I mentioned the last time the cholesterol article was posted you couldn't pay to take a statin. First time Dr. prescribed one and I didn't know too much about them about 10 years ago, I filled the script, looked it up on the web and then through it in the garbage. I remember the Dr. saying you might have leg pains from it. Statins to me is like taking a pain med for a headache but the side effects are you'll possibly have an ear ache, so which would you rather have. For women over 50 like myself, statins can possibly diabetes, so again which would you rather have.
1
Yes! Many of us just make too much LDL. No diet, exercise program, changes in sleep and stress, etc. is going to change that. It's on the spectrum of normal in the human body. If you get that body, as many of us do, then we are at a much higher risk of heart attack or stroke (clots cause strokes in huge numbers). Take the danged statin and lower your risk. Don't be a hypochondriac and attribute every little thing after that to the statin. Maybe up B12 or take CoQ, especially if you are a near-vegetarian, but discuss with your doc. Up your monitoring of A1C to make sure about pre-diabetes. But statins are helpful for so many people, and for most, also very cheap. Don't fight your doc.
10
@what? no smoked paprika? I cannot even count how many times I have wished I had fought my doc harder. At least six. You buy into everything a doc says--and then scorn people for thinking new aches and pains may be from a new medication?
3
Here's a simple way to break it down: "Secondary prevention" means you had an event, such as a heart attack or stroke, and use statins to prevent a future event. Everyone agrees that statins are useful in this population.
"Primary prevention," healthy people reducing their risks of a first event, for which Ms. Brody is using statins is much more dicey. For patients, it depends on the way a doctor present the evidence: Option one is, "Mr. Jones, the evidence shows that taking a statin will reduce your risk of a heart attack." Option two is, "Mr. Jones, if you and 80 other people take a statin, one of you won't have a heart attack in the next 10 years. (This is known as "the number needed to treat.") It makes a big difference.
One factual correction: statin used for primary prevention have not been demonstrated to either increase or decrease the risk of dementia
23
This is a good point, people are dumb at stats. If you take a drug to prevent an event from happening that was already unlikely to happen anyway, then your reduction is statistically relevant but not very impressive. The question is, do you want to be that one in 80 when you are lazy and eat too much meat and are overweight. I would do it, some people won't but they will probably beat me to the great beyond.
1
this is brilliant, jane brody is providing readers with an 'an analysis of the best available medical evidence.' and who would know this better than her, an old journlist with no medical experience or background. was elmo not available to fill this crucial role at the Times?
5
Please refrain from ageist comments!
4
Your points sound quite reasonable. And yet, as you said, science keeps evolving, and whta seems true today may not be tomorrow, as more facts and side effects emerge. It is a balance that must be individualized. A curious way of U.S. big-Pharma advertising brand name drugs directly to the public is a no-no in Europe, as it seems a move to sell the most profitable medications...while we may have perfectly good one's and with similar effectiveness in the generic arena. Oh well, it pays being alert to scams and to pitches of perfection where reality remains wanting.
2
No more meat. No more dairy. No more oil, sugar, or salt. No more statins.
5
@Toh14m
As Brody wrote, she cut fat out of her diet to avoid taking statins, and that didn't work to lower her cholesterol. She found her food intake was not the significant variable in her high LDL. As with many persons, her body was producing cholesterol even when her food wasn't. DNA likely plays a significant role.
I don't like taking statins at all, but I am in the same situation as Brody and am glad researchers took the effort to invent them. My sibling and I take statins, and we are all well past the age my father and grandfather (62 for each) died of heart attacks.
4
@Toh14m
Sounds awful
3
@Toh14m just shoot me...
2
I checked out the calculator. Age 67, non-Hispanic white male, total cholesterol 143, LDL 70, HDL 54, systolic pressure 117. Results? Take statins! This is not drug pushing?
50
@james willis
No, it's an uncaring, or unknowing, prescriber.
Statins do not prevent heart attacks and such. For a person with normal numbers they are not indicated.
Reflex prescribing is bad practice and dangerous.
2
@james willis
That's not the result- that's a probability. What you choose to do about it is the decision you and your doctor should discuss. And there are tools to help you refine your risk further (such as CAC scoring).
2
Stop relying on relative risk statistics!
2
Interesting article. Four points: Why did the numbers stop at age 79? Does the efficacy of statins fade at this age, or are there other factors involved, like cost and life expectancy? Second, mention of the calcium deposits, essentially "en passant" is curious. I would be more concerned about arterial calcium deposits than cholesterol excess. Third, this entire cholesterol problem/statin remedy is based on Ancel Keys lipid theory of heart disease from his seven country study, which some have argued that the results, like the countries, were cherry-picked. Be that as it may, is it possible that 40,000 years of meat eaters got it wrong? Finally, a comment on the article suggested that nineteenth century and earlier populations' life expectancy was 40 years. That's not true, except for life expectancy At Birth. If you made it to 40 and beyond, life expectancy was not all that different from ours in 2019 (which is slightly less than it was in 2018, by the way).
5
@NOEL QUINN
If you made it to 40 and beyond...
It’s that “if” that matters. There have always been a few people who live very long lives, and no one is saying everyone needs a statin, but millions have avoided early heart attack/stroke from their use. I am the first woman in my paternal family to live past 60. They all died of early heart attacks--as early as 40.
And, no, statin use is based on clear and substantial science, as Ms Brody clearly states--not Keys lipid theory.
"40,000 years of meat eaters" didn’t eat all that much meat and it was lean meat. They walked miles and miles to find that meat and much of their diet consisted of plants--nuts, seeds, berries, and roots. They would more properly be called gatherer-hunters to tell the truth.
3
@Pundette
Some did eat a lot of meat, others didn't, and it varied by region and season. Yes, other aspects of their lifestyle played a role -- nobody is denying the importance of exercise or eating nutritious foods.
The broader point is that eating meat and cholesterol has little or nothing to do with metabolic health and heart disease.
https://www.nytimes.com/2018/12/18/well/eat/is-there-an-optimal-diet-for-humans.html
1
I took statins for a number of years before I started having muscle degeneration. It wasn't clear that was what it was for about another year. It got so bad that I couldn't walk 100 feet without sitting down (and I am active, ride horses, etc.). I was told to go off statins then. A month or so after that, my Achilles tendon blew out; it rolled up like a window shade. I needed surgery and was out of commission for 6 months. That was a direct cause of statins (a side effect published in Europe but not in the US). These drugs are not as benign as big pharma will lead you to believe. I now take "old fashioned" cholesterol drugs which work very well for me. Just sayin' ...
7
@Suzanne Kelly
Lipitor caused me to suffer quadriceps total rupture in both legs, surgery and a long recovery. MD's agree that Lipitor was the cause. This "side effect" of muscle/tendon damage such as you experienced is not common but neither is it rare. This not to say that statins should not be used. It is to say that statins have risk, that risk varies across users, and caution is required. The idea that statins should be used by all is absurd and dangerous.
7
@Suzanne Kelly
Have you ever taken a fluoroquinolone antibiotic (Cipro, Avelox, Levaquin) over that period of time?
Muscle pain, fatigue, nerve damage and tendon damage and ruptures are all known side effects and can show up long after you have stopped taking the med.
3
What are old fashioned cholesterol drugs?
4
For me Atkins or Keto diet worked the best from 248 to 165 total cholesterol or LDL from 190 to 94. I tried low fat and vegetables, use flaxseed for four years every morning with fruits in the morning and cholesterol improved but stayed high, then I was prescribed statins, Lipitor first and started getting leg pains, then move to Crestor 5mg ( the smallest dose) and worked better. I am 61 years old, ride my bike to Bykram yoga twice a week and tried to have an active life. But in summary eggs and bacon ( or sausage) every morning, very low carbs and if any, green vegetables and the ocasional apple (I love honeycrisp apples) worked the best for me. So far this diet has brought my cholesterol down and my blood pressure normal, also lost 20 lbs. and of course my ‘pre diabetes” hemoglobin AIC has gone back to normal. I strongly believe sugar is the enemy, and vegetarian diets are too high on sugar. After trying for years I believe Dr Atkins was right. Granola is bad for you and bacon and eggs are good. disclaimer: I am retired, never been associated with any diet organization nor the bacon or egg industries i do prefer country eggs with orange yolk and natural sausage you can only find in a few places without nitrites preservatives that give that salty weird flavor. I am for for the All natural but with all natural fat.
7
@Rafael
After trying all else I, too, came back to Atkins. Two years ago lost 15#, last yr another 20#. Still working on ditching sugar but slowly getting there. For me, very low carb does it.
1
@Rafael same here. keto. lost 25 lbs. very low carbs, no sugar. no seed oils or processed foods. Grass-fed meats and dairy. organic eggs. organic greens. it feel great
2
I am a firm believer that people need to take their health into own hands, but I would caution against the naive believe that dietary changes alone, including a switch to a plant-based diet, can be a magic cure.
I am 5’11 and have always been a stable 135 pounds. I have always exercised frequently (I am a runner) and have followed a healthy diet low in saturated fats. After being told I had high cholesterol for over a decade, at 27 years old, a doctor finally prescribed a statin. My total cholesterol was 298, LDL 222. I resisted. I adopted a plant-based diet for a year, increased my fiber intake, and took supplements including krill oil and plant sterols. After a year of this, total cholesterol fell to 270.
I finally relented. I now take a low-dose of a statin and my LDL hovers around 90. My HDL, which was always higher than average, is now around 65. I still exercise daily and limit my intake of saturated fats, although now I incorporate lean animal protein sparingly.
Will I probably take statins for the rest of my life? Yes. But they have a use for people like me and countless others, for whom exercise and a healthy diet (including, in my case, a 100% plant-based diet) does nothing.
We are all different.
35
@Michael What you've done was lower your LDL.
May I ask, did you happen to have been prescribed a hydrophilic (rather than a lipophilic) statin?
With a similar situation to yours (high HDL, exercise, etc) I happened to have been prescribed a lipophilic statin and sentenced to ten years (so far) of weakness, pain, torn connective tissue, and other true nightmare.
LDL numbers are what's called a surrogate marker: yes, statins lower LDL numbers. But lots of other things too.
Under certain specific conditions (mild mental impairment, mildly high cholesterol, lipophilic statin) one's chance of Alzheimer's is doubled over the next 8 years.). This can't be extremely uncommon....
As a fit now 70 year old , I was surprised (understatement) fifteen years ago to have a coronary calcium score of 5,860, which may be a record . No symptoms. Cholesterol never over 200. I received a double bypass and nine stents since then along with statins, low dose, now Crestor with no side effects. Diet? Heredity ? My guess is that stress with resultant cortisols over a 30-40 year period with resultant inflammation is /was the culprit. Any comments would be welcome.
4
the only way to lower your cholesterol without any adverse(life changing , life modifying )side effects is to adopt a plant based diet....reducing my animal products ingestion significantly changed my cholesterol profile. to all those who are arguing about statins use, i challenge you to try rhis lifestyle change. there are also doctors now who practice and preacribe this. i am a doctor who recommends this for all people.
3
@lola4md
I was a vegetarian for twenty years when I got a stent at 49. I’m still a vegetarian and I now take a statin--with no discernable side effects after 20 years.
It depends whether your high cholesterol is caused by diet or is in your genes (it can be both, of course).
10
@lola4md
Cholesterol-lowering through diet has been tested extensively for decades. It succeeds in lowering cholesterol, but broadly fails to reduce heart disease or all-cause mortality.
Almost as if cholesterol itself were not the root cause of these problems...
4
If you are a doctor, you're aware of the fact that for some people, modifying diet alone, is not sufficient.
2
After switching to a plant based diet, my cholesterol dropped 60 points in 12 weeks. We can’t expect medicine to help us, if we are not willing to help ourselves in the process.
6
@Toh14m yes. Mine dropped from 308 to 207. I write because I spent a week researching (without success) to see what kind of drop was doable thru diet. (As she finishes her steel cut oatmeal w bran buds, almonds, and an about-to-be-compost banana.)
4
I’m so glad that a plant based diet worked for you, and for others. But to assume that everyone who needs to take a statin is not taking other steps to care for themselves is deeply offensive.
I have had total cholesterol levels of over 350 since I was born, LDL of 295. I exercise, maintain a very healthy weight, eat a diet rich in fruits and vegetables, with no red meat, no eggs, low sugar and low to no saturated fat. I do this because taking care of myself is a priority, but it does nothing, absolutely nothing, to bring my cholesterol levels down. Statins do that, and I take them every day. I have no doubt they will prevent a premature cardiac event and allow me to live to see my three daughters grow up.
When at 17 you see your father experience sudden death due to a cardiac event (an event caused by elevated cholesterol levels that you inherited), when your uncle has a bypass at 28, when your sisters are also diagnosed with levels well above 350 .... when you have lived with the fear of a premature cardiac event since your cholesterol levels were first tested at age 10, you do everything you can to ‘take care of yourself’, including listening to well established medical science and taking your statin.
11
@Toh14m Good for you. But many people have bodies that make too much cholesterol no matter how vegan they are.
4
Can somebody please answer a simple question.
I am 70, have high cholesterol, but exercise 6 days a week, have a good diet, good weight and excellent blood pressure. What is the increase in life expectancy if I go on statins?
Numbers please, in days and weeks. Also in risks, i.e no "increase the risk by 25%" without saying what actual risk is. Also, references please.
6
@Peter O'Neill's grandson
I think you are looking for the "number needed to treat" For people without a prior coronary event, about 500 would have to take statins to save one life. For you, it might depend on how high the "High" LDL is and other things like triglycerides - but talk to your doctor. You can also use the coronary risk calculator online and play with the coronary risk for different cholesterol levels. See if it makes much difference in your case.
2
Excellent questions.
2
@Peter O'Neill's grandson
You should probably ask a doctor these questions not random people reading the news.
8
Here follows my own statin story. Twelve years back, recovering from complex spine surgery, I was prescribed a statin for borderline high levels. Added to the litany of meds I already was taking it blended in. A long slow recovery of several years left me in a lethargic state wondering when I would resume my life. During that time my blood sugars were on the rise. I was warned several times but to no avail, I developed TypeII and added more meds. Sugar was not well controlled nor was my return to normalcy.
The cost of meds was high, the statin was very high. Mt ldl was pretty much unchanged. I decided to cut costs and eliminate it. The rest of the story is remarkable.
within a week or so I became alert and my daily glucose levels were dropping. I felt like I had been shot out of a cannon. fast forward now ten years, still no sign of diabetes.
My revelation at the time that t
12
@R.L.DONAHUE
I was saying; my revelation at the time of statin causing high blood sugar was discounted as no so. at that time there was no correlation disclosed that statins can cause diabetes. To this day that aspect of my care has never been acknowledged, I suppose due to liability.
However, i do believe the research and am now once again taking a statin of a different formula and watching the blood sugars.
Despite the terrible side effect I suffered I am still of the mind that statins do save lives and prevent heart attacks as well as lowering ldl.
You have to find the right one and watch your labs.
4
Better written article than last time. For hereditary high cholesterol after diet and exercise, then statins are worth it.
For most people however, sleep, diet and exercise works very well. People who have severe heart disease should check Dr Esselstyn diet. He is a cardiothoracic surgeon who essentially got fed up doing bypass surgeries and tried successfully non surgical means to treat and prevent heart disease.
Unfortunately there is no money to be made, so not much publicity about it.
3
@HR I appreciate that you mention hereditary high cholesterol. I found out at 18, while training for the Junior Olympics in volleyball (best shape I'll ever be in), that I had cholesterol levels of 380 and my LDL around 280. My diet was regimented and I exercised nearly 5 hours a day, plus the high metabolism of a teenager. I simply lost the genetic lottery on cholesterol. Statins have been instrumental in managing my levels and I believe they are a godsend for people who cannot lower their levels through "lifestyle choices."
2
@HR
Many quacks have MD after their names. There is little money in generic statins--mine runs me less than
$10/3 mo, full price, not copay. The reason this column had to be written is because of thinking like yours, which sadly tends to get entrenched regardless of facts.
2
@AM
So they can die of cancer or Alzheimer’s instead of heart disease?
2
Those 20 + percent effects reported in the article are "relative" as compared to a placebo. In "absolute" terms it may be much much smaller.
If a symptom occurs 5% under a placebo, and 4% under a drug treatment, Big Pharma encourages reporting a 20% reduction. 5% - 4% = 1% (divided by 5% gives you the 20% relative reduction) The absolute reduction is 1%. You decide.
5
My cholesterol went from 266 to 108 by use of a statin. Which would you choose to have? Oh, I should add my heredity set me at 200+.
6
"they stabilize the plaque that narrows coronary arteries."
It was after blockage of a coronary artery and the necessity of a stent implant, that I agreed to go on atorvastatin (generic Lipitor). What choice? I for some time been on the weaker statin, Pravachol, but had given that up based on all the negative reports about statins really being of little value.
1
Statins are the new low dose aspirin. Once thought to lower the risk of heart attack but newer tests have debunked that to the rate that folks over 70 are told to stop daily aspirin regimens. Statins will most likely go the same route. Also a 20plus per cent drop in risk factors is not all that encouraging considering all the other variable factors in the human body. It means there is still a 70 plus percent chance you’ll still have a heart attack. Jury is still out on this one.
8
@David Gifford low dose aspirin shouldn’t be taken if you have no cardiovascular risk. Statins also shouldn’t be taken if your LDL is in the normal range. I’m not certain of your point. Aspirin and statins are effective in adults with significant cardiovascular risks
7
Qualifier to your comment. There really isn’t a normal range for LDL. Decisions should be based on risk and the context of LDL-C is important but that single number does not tell you enough about the potential benefit of a statin.
2
@MD
There is no normal range for LDL? LDL particles have no adaptive purpose, and lower is always better?
2
I have celiac disease (an auto immune disease) and IBS. I also tend to have higher than average cholesterol levels. About 20 years ago my well intentioned GP prescribed a Statin despite my diagnoses. I experienced terrible side effects...akin to a bout of the flu. It destroyed what was left of my gut biome. If you have any digestive issues steer clear of these drugs. I have found slo release Niacin to work pretty well and I take a very low dose of it.
3
@Jo: I tried the niacin route once. I turned as red as a traffic stop sign and felt like I had been poisoned. There is no free lunch for anyone when struggling against potential blockage of the coronary arteries. What works for one, is beyond tolerance for another. It is a trial and error game.
6
@Jo
No statin has any effect on the gut biome.
There is another version of the so-called lipid hypothesis -- that cholesterol causes heart disease. And it centers around the Seven Countries Study by Ancel Keys, which is the origin of the theory. But Keys actually studied 22 countries and cherry picked the data to come up with his theory.
Some authors have virtually accused Keys of medical fraud, asserting that it is not cholesterol that causes heart attacks, but inflammation, mostly from sugar, and stress, that are to blame. They have a lot of science on their side.
Some references: "The Great Cholesterol Myth" (Bowden)
"The Statin Damage Crisis" (Graveline)
"The Truth about Statins" (Roberts)
"The Cholesterol Myths" (Ravnskov)
"Lies my Doctor Told me" (Berry)
(There are other such books)
Additionally, statins are not harmless and, in addition to the worst case, rhabdomyolysis, may damage muscles, tendons, organs, and the brain.
Some other negatives: The British Medical Journal reported on a Finnish study of 9000 white males that found a 46% correlation between statins and type 2 diabetes. Another study found that statins increased a breast cancer survivor's risk of an aggressive second cancer by 50%.
There is other evidence that all-cause mortality is lowest among people with HIGH cholesterol...that it may also protect against dementia.
The medical establishment's endorsement of statins, frequently citing studies paid for by big Pharma, has made Lipitor and other brand name drugs a pharmaceutical gold mine.
28
@TMaertens
Thank you for your comment and the correlation between low cholesterol and dementia. The book, Grain Brain, by David Perlmutter, MD spends a lot of time discussing this phenomena, and how our brains need fat in order to function well. Its interesting how the incidence of dementia and Alzheimer's has skyrocketed since everyone has been all nuts about low fat high carb diets.
3
@TMaertens
The 22-country graph comes from a 1957 paper from Yerushalmy and Hilleboe, which stemmed from a critique of Key's 1953 paper and his conclusion that fat intake was highly correlated with heart disease. They argued that Keys was cherry-picking data for his six-countries graph; he responded that many of these countries had data that was unreliable.
Regardless of the merits of each argument, the Seven Countries Study had nothing to do with this data.
The SCS began in 1958, and all of the data used in that study was original data collected by the University of Minnesota research team led by Keys, and their international collaborators.
Keys' thinking evolved quickly as scientific evidence became available, and by 1961 his position on dietary fat was refined to differentiate between saturated and unsaturated fat.
In any event, he is but one researcher among thousands, and the SCS one study among thousands of studies on heart disease. The current state of knowledge on heart disease is based on a large body of evidence which spans decades and continents. To elevate Keys into some kind of imaginary supervillain with the power to single-handedly manufacture scientific consensus even long after his death is absurd. Such a result paints the entire research establishment - encompassing hundreds of outstanding university research departments and independent laboratories and thousands of scientists - as are either corrupt or victims of one of the world's largest hoaxes.
4
@childofsol
It's funny how your "large body of evidence" always excludes the past two decades of research which have both failed to find any dangers from saturated fat or cholesterol consumption, and have consistently found _benefits_ to low(er) carb, high(er) fat diets.
Keys is the poster boy for shoddy science and cherry-picking to get desired results. Even if his results were valid at the time, they have been disproven now.
4
A nearly 10% chance of getting type 2 diabetes. A disease that also can result in strokes, heart-attacks plus blindness, amputation. Wow! And this is okay with everyone?
15
See other comments. Statins do not cause diabetes. They may elevate blood sugar slightly in people who are already close to the threshold. And they work particularly well at lowering the risk for heart disease and stroke in people with advanced prediabetes or diagnosed diabetes..
3
@MD My impression is that the knowledge of the statin-diabetes relationship is more open than you suggest: https://www.nytimes.com/2019/03/07/well/live/statins-may-increase-risk-of-diabetes.html is one recent article but more scientific links include: https://www.medicalnewstoday.com/articles/319832.php and
https://www.medscape.com/viewarticle/840884 and from the UK:
https://www.diabetes.co.uk/news/2019/mar/Statins-associated-with-38-per-cent-increased-risk-of-type-2-diabetes-97343893.html
I agree that obese and otherwise diabetes prone patients are more likely to have bad statin responses in terms of developing diabetes than thin/normal ones.
2
@MD
Well they may work well in lowering risk for heart disease but I can't see how if when taking a statin, one's sugar numbers go up by 30-50 points. Seems like a catch 22. Take the statin, even a low dose one, have your numbers climb to unacceptable levels, which means you need more medication to control the diabetes.
2
The so-called lipid hypothesis -- that cholesterol causes heart disease, is under dispute It centers around the Seven Countries Study by Ancel Keys, which is the origin of the theory. But Keys actually studied 22 countries and cherry picked the data to come up with his theory. Some authors assert that it is not cholesterol that causes heart attacks, but inflammation, mostly from sugar, and stress. They have a lot of science on their side.
"The Great Cholesterol Myth" (Bowden)
"The Statin Damage Crisis" (Graveline)
"The Truth about Statins" (Roberts)
"The Cholesterol Myths" (Ravnskov)
"Lies my Doctor Told me" (Berry)
“Fat and Cholesterol Don’t Cause Heart Attacks and Statins are not the Solution.” (Kendrick et al)
“The Dark Side of Statins.” (Davis)
Additionally, statins are not harmless; besides the worst case, rhabdomyolysis, they may damage muscles, tendons, organs, and the brain.
Some other negatives: The British Medical Journal reported on a Finnish study of 9000 white males that found a 46% correlation between statins and type 2 diabetes. Another study found that statins increased a breast cancer survivor's risk of an aggressive second cancer by 50%. There is other evidence that all-cause mortality is lowest among people with HIGH cholesterol...that it may also protect against dementia. The medical establishment's endorsement of statins, frequently citing studies paid for by big Pharma, has made Lipitor and other brand name drugs a pharmaceutical gold mine.
11
There is ZERO evidence of a Statin ever improving the heart health of ANY woman. Ever. Not one.
And here is why taking a stain doesn't work anyway. Cholesterol doesn't cause heart disease or heart attacks. So lowering it doesn't do anything to benefit your body. However, Statins do an immense amount of damage. Primarily because Statins BLOCK absorption of CO-Q10 and Statins are an antibiotic--so they destroy your gut biome. You’ve had many articles in this paper on gut biome.
Any doctor who prescribed a long term Statin should, in my opinion, lose their license to practice medicine for violating their oath to do no harm. It's pure quackery for profit. As they and the pharmaceutical companies are the only ones who profit.
Did you know that in Canada, Statin makers have to place a warning about the CO-Q10 issue on the insert? But the same companies don't tell Americans. Are Canadians a different species?
Did you know that doctors get HUGE end of year bonuses from pharmaceutical companies for prescribing their particular drugs. And at the top of my clinicians bonus money is their payoff from a Statin maker. I personally know someone who passed out the end of year checks from ONE company to the doctors at her clinic. The smallest check was $45,000. Let that sink in.
But unless you want to risk severe muscle damage and increase your chances of a stroke or a heart attack, better to fix your diet than to take a Statin.
14
@Frank Priebe I have never in over thirty years as a physician received any money from a "statin maker" to entice me to Rx their products; nor do I know of any other colleague who has received a kickback except maybe cold pizza (ironic). If you are certain that this occurred then you should report the clinic to the Feds. Stain treatment should be a shared decision between a physician and the patient with risks and benefits clearly defined and regular followup mandatory. I take low dose aspirin atorvastatin myself since I have known CAD discovered on a workup for valvular heart disease and also take and recommend CoQ10 as well since it may attenuate side effects and doesn't seem to hurt except the wallet. We will know more in twenty years but in the meantime the plaque goes on. Coupled with diet and exercise statins are effective drugs for lowering cholesterol as of 2019 and in the future I am certain that we will discover better drugs but this is what we have now and we should use them in the proper clinical context.
29
@Frank Priebe, thank you for one very important piece of information. I have consistently had gut dyspepsia from taking statins. I could not find much in the literature about statins and the gut microbiome, but I came to the conclusion, after several bouts of going on and off, even a very low dose of atorvastatin, that my gut microbes were getting hammered in some way. So, glad that you mention that statins are an antibiotic.
I am a scientist, so I have done repeats of this experiment, admittedly only on myself.... but I can take the statin for several months, then I start to have gut upsets, which I allow to go on for two or three months, then I stop the statin. After a week or so my gut feels pretty good so I stay off the statin for a few months. Then my cholesterol numbers go back up so I go on the statin and the cycle repeats itself. I have done this cycles at least 6 times now.
Two years ago I took the Ornish course, which was a miracle at dropping my blood pressure into normal range. I now eat only veggies and fish. My liver, however, continues to make lots of cholesterol, so I hop on the statin wagon for a bit every once in a while. And then use probiotics in yogurt to get things back in line.
5
@Vincent S Panella, MD
Yes, but conspiracy theoris are so much more dramatic!
3
Dietary fat doesn't cause high cholesterol. You'd think it would, and doctors said for years that it did, based on NO actual evidence, but it's not true, even if Jane Brody keeps banging that drum. This has been steadily debunked and acknowledged as metabolic diseases have climbed since those low-fat dietary guidelines were universally implemented. I really wish Brody would quit banging that drum. Cutting dietary fat doesn't cut blood cholesterol.
18
That is an incorrect blanket statement. For many patients it works very well. But not all. You are correct to say that substituting sugars for fat is not a healthy outcome. Thank Big Food for that.
4
@MD "for many....works very well" is very vague.
What are the "number needed to treat (NNT)" for 5 years of statin use to prevent one coronary event? (Hint: It's about 100 patients).
4
@Comp
Brody only bangs the drum of well-established science, whereas you cite nothing. One presumes you refer to the plethora of books written on this by people (who make money on these books) with poorly supported claims in spite of loads of footnotes. Most people are not equipped to know a good study from a bad or silly study, which is why we should listen to the views of those actual experts who rely on the body of evidence, not cherry-picked studies of dubious quality.
1
My mother recently died at the age of 93 after years of suffering from advanced diabetes, macular degeneration and assorted ills. She was kept alive by taking 20 or more prescribed drugs daily. The nursing home where she spent her last days was a warehouse of suffering and dying people consuming large quantities of drugs and medical care which kept them alive to suffer longer.
No thank you. We have the ability to extend life, but not to make it tolerable. I would prefer a natural death at an earlier age rather than prolonging life long after all quality is gone. That seems to be the goal of medical care in the US today. It keeps the medical and pharmaceutical industries happy, if not the recipients of their care.
51
@T. Wallace Sorry you lost your mother, and that you and she had to go through that awful time. I agree re. nursing home-hell on earth.
3
@T. Wallace
Apples and oranges. I am alive and well with the help of statins, blood pressure control meds, a healthy lifestyle, and some good luck no doubt. The diabetes disappeared when I lost 45 lbs, which I’ve maintained for nearly 15 years. While my risk has been lowered substantially for heart attack and stroke, and I don’t take anywhere near 20 pills (four, including low dose aspirin), I could eventually suffer an event that if I survived it, would land me in a nursing home. No one forced your mother to take her pills and quality of life if a very subjective matter. Do as you like, but I’ll take my pills and advocate for improving nursing homes. Also, there are alternatives to nursing homes, such as in-home care. There is also a new effort being made to give greater attention to the number of meds the very old take--its a balancing act.
7
You’re sounding pretty defensive at the beginning of this column and you shouldn’t be.
I started taking statins about 6-7 years ago as my cholesterol had been creeping up each year and after I heard two family friends who are GPs agree that “everyone “ should take statins.
Since then, my cholesterol has fallen by about 1/3 to 155, lower than my 22 year old vegan daughter.
No side effects at all.
My question aims at looking past the numbers!themselves: is having a cholesterol level of 155 as ‘healthy’ as if I had a level of 155 ‘naturally’ (ie, without any drugs)?
4
I too have genetically high cholesterol. I don’t smoke, am active physically and eat a very healthy diet. My doctor perscribed statins starting in my early 50s. The first made my wake up in the middle of the night , my tongue so swollen that I was gagging and gasping for air. Over the course of several years my doctor tried the various brands of statins and they all caused dramatic muscular issues. After several years on no statin meds, he had me visit an endocrinologist to discuss Praulent, a twice monthly injectible medication. This med was developed specifically for people like me with genetically high cholesterol. The medication works like a charm. I’ve been on it for over three years and my cholesterol is in a normal range with no side effects.
6
Good new drug class. Expensive and not for everyone but it sounds like you fit the appropriate type. Good decision.
2
Ms. Brody refers to a single digit increase in diabetes risk from an earlier study but a more recent and larger study (Erasmus University Medical Center covered 9500 patients for 15 years) found a 38% increase in diabetes risk from statin use. Given that 25% of those over 65 have diabetes, that translates to one in nine or ten older patients facing diabetes risk with statin use while one in 100-150 healthy people (no previous coronary history) need to take statins to prevent a heart attack. I agree that individual decisions should be made in consultation with a doctor, but for general advice, the balance of risks seems worse than she has indicated. (I take 20 mg pravastatin but am of normal weight and overweight people are more likely to get diabetes.)
4
Statins do not cause diabetes, they may accelerate the date of diagnosis in a few who will become diabetic anyway - by an average of 5.4 weeks. And people this close to diabetes or with diabetes are the ones most likely to benefit. We don’t prevent diabetes by withholding statins, we prevent it thru lifestyle and need statins to help prevent the major outcomes of heart attack, stroke, and death in higher risk and diabetic patients.
6
@MD I would appreciate a literature citation to support your statement that statins may accelerate the date of diabetes by 5.4 weeks. My reading of the literature is not the same as yours, but I am not a medical doctor.
4
@DavidD
You bet. Here is the link to the publicly-available paper.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3774022/
1
I have been on statin's now for more than a decade.
I almost immediately experienced the muscle soreness once I went on a 10mg dosage of Lipitor, and was switched to Zocor - with which I experience no symptoms.
In the interim, I began taking CoQ10 - and when my cardiologist later suggested that I give Lipitor a 2nd try (since it was considered the more potent drug), I went back on it, experienced no side effects, and have been on it ever since.
My cholesterol numbers have never been better, and with the addition of a daily fish oil capsule (I know, another no-no according to the alleged experts...), my HDL-LDL ratio have never been as good.
What it all means in the cosmic scheme of things...who knows?
I do believe this. In the future, good medicine will be individualized medicine - a medicine that is personalized for your lifestyle, body type, genetic and energetic makeup, dietary preferences, etc..
I believe that these meta-analyses that are all the rage, and which tend to discredit smaller studies that show positive impact with a specific population, are as useful to actual human beings as Dan Aykroyd blending a fish in a veg-o-matic (in the old classic SNL skit).
1
Your experience is typical. Among the 5-10% of people with muscle aches actually due to statins (most are not -we all get muscle aches) the vast majority can tolerate a different dose or different statin (there are 7 of them in the class) just fine, and get the risk reducing benefits.
1
Just another data point: like the author, my body makes too much cholesterol.I am 70 years old, and I have been on 10 mg. Simvastatin for 10 years. My lipid profile is now well within the guidelines, I exercise every day, including 100 chinups or pullups every day. I have had no muscle problems, nor problems of any kind with the treatment. Our modern pharmaceuticals are very potent, and, as such, will produce side effects on some people. For example, I cannot take aspirin. That is why medicine is a science, but also an art.
5
I have been using Simvastatin for many years (40mg/day) due to somewhat elevated cholesterol level. Two years ago, I had forgotten to bring my medicines when I was away from home for a week. When I took my usual 11 km run, I seemed to be running easier, and I then remembered that long ago, when I started on statins, I had been warned that statins could give muscle pain. I had not experienced that, but I thought that perhaps statins had influence on the muscles I used when running. Therefore, I decided to stay away from statins until I had sufficient data. My running became statistically significant faster. But my LDL cholesterol had increased to an unacceptable level. I went back to half dose of Simvastatin (20 mg/day), and my LDL cholesterol dropped back to the previous acceptable level, but my running times stayed significantly faster. My time in the Oslo 10 km run decreased with 6 minutes. I did a literature search, and there is a lot of published scientific evidence that statins have a negative effect on exercise performance.
I am 77 years old, and has been a vegetarian for 40 years.
7
You don’t mention the HDL or triglyceride readings or the particle size. If each one is in normal range, it detracts from the risk of the LDL you mention. My risk of heart problems is less than 10 percent but Duke doctors push statins anyway. It seems if you reach a certain age, they also want you to take blood pressure medicine. It is the test-and-prescribe mentality, not to mention stereotyping. I have no risks other than a bad family history. But I will see a preventive cardiologist for a few tests that will check for other risks.
10
This is the reason i discontinued my statin use:
Low energy and fatigue have previously been reported by patients taking statins, and the association has been noted in observational studies, but this is the first placebo-controlled, double-blind, randomized study to identify excessive tiredness as a statin side effect.
The study enrolled 1016 men and women with LDL levels of 115 to 190 mg/dL and no cardiovascular disease or diabetes. The subjects were randomized to receive either simvastatin 20 mg, pravastatin 40 mg, or placebo for six months.
Results showed statin use significantly worsened energy and increased fatigue. Both simvastatin and pravastatin contributed to this effect, which was worse in the women than the men. Not surprisingly, the participants with reduced energy also reported significant decreases in their actual activity levels, which could in turn lead to additional health consequences.
Based on the findings, Dr. Golomb estimates that fatigue and excessive tiredness occur in 20% and 40% of patients taking statins.
15
@frank perkins Could you post a link to this study?
1
The “Mediterranean Diet” Jane refers to is actually a whole food plant-based diet. I suggest anyone with high cholesterol follow this diet as outlined by Drs. Caldwell Esselstyn or Ornish. Unlike any other diet in the world, they have clinically proven this diet can reverse heart disease. I’m not sure why Jane doesn’t acknowledge this fact because it could save many of the 600,000 people a year who die from a heart attack.
8
@James McNeill
It is not the Ornish Diet, but the Ornish Lifestyle Program. He can only show results if the people also quit smoking, exercise and undergo stress management. It is very likely one can get the results by doing these things without the diet part. See more here:
https://www.scientificamerican.com/article/why-almost-everything-dean-ornish-says-about-nutrition-is-wrong/
3
@James McNeill
Nobody who has actually been to the Mediterranean would describe any Mediterranean cuisine as a "plant-based diet." This is vegan wishful thinking.
In various countries of the real Mediterranean, they consume plenty of lamb, pork, ham, seafood, cheeses, yogurts, and full-fat dairy.
3
The Mediterranean diet was a mostly-plants diet, as were nearly all traditional diets. The nutritional transition has resulted in the same dietary changes in the Mediterranean region that occurred in other parts of the world: a decrease in the consumption of whole grains and legumes and an increase in consumption of animal products.
If people were confused about statins, after reading your column they should be more confused now.You never mention HDL or triglycerides, two important factors in assessing someones health risk HDL cholesterol above 45 for men and 50 for women is considered good with an accepted LDL three times that number for a ratio of 3:1. regardless of the total number. Triglycerides should be below 150. You should consult a lipid scientist to get a clearer picture of the importance of both HDL and LDL.
39
@charles macelis
You didn’t mention the NMR profile that looks at particle size. Big, fluffy particles do not cling to artery walls.
4
I have taken statins for about a decade. I had problems taking Lipitor (muscle soreness) and Crestor (loss of concentration), and my doctor put me on Pravastatin about 4 years ago. All was fine for while, but then I suffered from almost unbearable muscle stiffness and soreness, especially after exercising. When I went to my doctor, his PA noted my statin prescription and asked if I took Ubiquinol supplements. I had never heard of Ubiquinol, which I understand is a form of CoQ10, a coenzyme used by muscles that statins apparently strip out of the body. I started taking Ubiquinol the next day, and since then I've had zero side effects from the statin and a total cholesterol reading of 130. Based on my experience, I recommend that anyone having muscle-related side effects read up on Ubiquinol and discuss with your doctor.
24
I am reluctant to enter into this conversation, because most writers seem to be much more educated on the subject than I am. But I feel obliged to share the success I've enjoyed in reducing my cholesterol score thanks to a very simple recommendation from my physician. My total score had been climbing slowly but steadily into the mid-200s in my late 60s, despite a very active lifestyle. My cardiologist advised me not to worry, because with an HDL score between 95 and 100 I was going to have an above-average total score. My personal physician was unhappy with the cardiologist's position, but I was adamant about not taking a Big Pharma statin. She proposed a compromise, invoking her Chinese heritage: I would start taking a red yeast rice nutraceutical, which provides lovostatin, apparently one of the few naturally occurring statins. (Under pressure from Big Pharma, the FDA finally prohibited red yeast rice products from listing lovostatin as an ingredient on their labels.) After taking one red yeast rice pill in the morning and one at night for several months, my total cholesterol count dropped from 265 to 195, while my HDL count remained in the high 90s. I've been on this regimen for three years, have never suffered any side effects, and remain a happy mid-70s athlete.
31
@Bill Knox my cardiologist (in France) prescribed a red rice supplement for me and I have also had excellent results. I took statins for one month but did not tolerate them AT ALL.
6
As noted, you ARE tolerating a statin - lovastatin - which is one of the 7 available. IF you and your doctor decide you need one, it is rare not to find a drug and dose that can help to lower your risk safely and without side effects.
4
Thanks Jane,
I actually cannot take a statin because of the muscle problems you mentioned (e.g., my CK went up to 522). I have taken ezetimibe (Zetia) for almost a decade but its efficiency is nowhere near that of a conventional statin. Any thoughts?
1
Thanks for this piece. I spent about 15 years trying to manage high cholesterol and LDL through diet and exercise. My cholesterol bounced from 210-240. 3 years ago when I retired, we stopped eating meat and I have lost another 15 pounds. I live in Colorado, lift weights twice a week with a trainer and hike on average 20 miles a week in high altitude. I also ski. I get a lot of exercise for a 63 year old. Still, my cholesterol stayed high. My doctor recommended the lowest possible dosage of a statin, along with the same of a blood pressure medication.He prescribed generics which were very inexpensive. He showed me the impact on my longevity (using the calculator you mention) if the medication was successful. It was. My cholesterol dropped to 140 and has stayed there. The meds have had no impact on my health. Your article reflects my experience.
17
@Peter, Why did you wait so long to start!
Quantitative science makes me more comfortable in following the advice of experts and advisers. I would appreciate receiving from Ms Brody a quantitative response on the percentage of cholesterol in the blood that comes from the food we eat. And how do we know what percentage of the plaque in the arteries comes from this food percentage of cholesterol?
11
@Rich, have you tried doing your own research?
1
@Blue Jay Indeed I have. That's why I posed the questions carefully. What comes from the science is that people who have heart disease should be on statins. The fact that statins lower LDL does not mean that LDL causes heart disease. If a person wants to lower their LDL, for whatever reason, your food is an insignificant factor.
Between the vaccine truthers and those who cry "big pharma" at every turn, I'm done. Let the backlash commence. I have been a model dieter and exerciser: years of salad dinners, no soda, homemade everything, step aerobics and yoga. My high LDL wouldn't budge. When I considered my family history, statins just made sense, and they've worked. Those who are making it their life's work to crusade against other people's effective medicines need another hobby. They only play on the fears and neuroses of those already disposed to be alarmist, or those who have trouble drawing logical conclusions. For example, an overweight, 78-year-old relative quit her statins because her "legs hurt." Of course her legs ached: she's 78, obese, and sedentary.
147
@Blair
I can only crusade for my own response and am happy for positive results in others as I'm sure are most people as statins are cost effective. Four weeks in on a statin I felt the strangest form of muscle lethargy I have ever experienced. It was not subtle. Nor am I obese or sedentary. (& geeze give her a break @ 78 years old!)
PCSK9 or Repatha is a different subject. I had a dramatic turnaround in 3 months but the struggle to manage the high copay IF my Medicare/supplement authorizes it is another column. This cost must come down to benefit the many who need it. Not sure how long I can hang in there financially.
10
@Genevieve, Try one of those apps that reduce your co-pay. They make the equivalent of coupons.
2
If the only thing that was wrong with your health was a number, how do you know you that would not have remained physically healthy without taking the statin, other than your doctor’s belief in the “current science”?
3
I have been on Crestor since August and just decided yesterday to take a break. I have been suffering from cognitive/memory issues which seem to coincide with my taking the medication. I am sure that it's helping my cholesterol, so I really don't want to discontinue, but I need a functioning brain.
19
Good idea, kr. At age 44 I was prescribed the lowest possible dose of Lipitor due to a total cholesterol level close to 200. A few months later I noticed I was suffering from significant short-term memory (STM) loss. I read up on Lipitor's side effects and learned that STM loss is one of them. I quit the statin and my STM quickly came back to normal. Today I'm 61 and my risk factor per the CV Risk Calculator is only 2.3% despite a total cholesterol reading of 205. My LDL is 85 and my HDL is 100, which my current doc attributes to the fact that I eat lots of nuts. (I mostly eat a Mediterranean diet but will indulge in a steak occasionally. full fat Greek yogurt every so often, and a little bit of heavy cream in my coffee every morning.)
3
Lipitor might cause you less trouble.
1
What are the differences in LDL levels between women and men? Do most of these studies report results for men?
14
Great article except that it fails to mention that habitual drinking reduces a statins effectiveness.
5
Why has no one mentioned the whole food plant based diet not the Mediterranean diet. Time to move away from big pharma for information and take responsibility for your own health. Take the time to watch Forks over Knives and review the documented works of Drs. Neal Barnard, Dean Ornish, T. Colin Campbell and Caldwell Esselstyn, Jr just to name a few. Give yourself 30 days to fully commit to this new way of eating. This is not a diet but a life saving choice. Then and only then can you really decide whether statins are right for you.
23
Yes, you are COMPLETELY correct. But it can be a difficult, if not impossible transition. Statins can can help in the meantime
3
@Cindy
Barnard, Ornish, et al recommend a low fat, low protein, all starch and fiber diet. If that sounds useful, healthful, or appetizing to you, knock yourself out. Such a diet would be a disaster for my blood sugar, and produce constant hunger, lethargy, and weight gain.
3
@The Pooch
I followed Ornish, Barnard, et al. and dropped my A1C from 8.0 to 6.1 in 6 months. My P-C-F (protein-carbohydrate-fat) breakdown averaged 15-70-15 at 2400-3000 calories a day with >70g of fiber. I also lost weight. Carbohydrates (starch, sugar) are not the problem, insulin resistance is the problem, and insulin resistance is related to the fat content of your diet. And the majority of fat in the American iet comes from meat/dairy/eggs and processed oils. Get rid of these things and the insulin resistance resolves.
At least admit that that you are addicted to meat, eggs, dairy (cheese, anyone), and processed food. Be honest and do what makes you happy but do not pretend to have knowledge that you do not.
2
Dr. Esselstyn gets very little attention from AHA and most of the practicing medical professionals, even though he showed very convincingly that diet alone can not only prevent but even reverse the heart disease. Yes, it is hard to change life style, but would you rather take pills or change diet?
http://www.dresselstyn.com/
25
@Jaque
And do not forget Pritikin, Ornish, Davis, McDougal, Barnard, Novick, Campbell, and Fuhrman, to name a few. I slashed my cholesterol from 187 to 130 in a few months following their advice. And I was NEVER HUNGRY. Also lost weight, blood pressure came down, A1C dropped, and triglycerides came down.
3
@Jaque: Esselstyn, Campbell, the China Study .... all have been totally debunked as fanatics, quacks and liars.
Veganism is a religion for them, and they proselytize it relentlessly, like Jehovah's Witnesses.
2
Thanks you for a very balanced and helpful column. I resisted stations for a long time but finally judged that diet could not lower LDL sufficiently, given a very high LP(a). My one criticism is the recommendation of various oils. Please please read Esselstyn and Ornish on the endothelial damage done by oils in the diet. For people with arterial plaque, which is nearly everyone, there seems to be no such thing as a benign oil.
6
I applaud Jane's attempt to try diet and exercise versus taking the statin for a period but I question her dietary choices. If you truly want to try lowering your cholesterol without statins, you need to start with stopping to ingest cholesterol. A tablespoon of fish oil has about the same amount of cholesterol as 12 slices of bacon and there are no peer reviewed studies that prove fish oil provides any benefit at all to prevent cardiovascular related diseases. Fish while low in saturated fat, also has cholesterol like any animal product. You can obtain healthy Omega 3s by eating small amounts of walnuts, flax, or chia seeds and avoid the cholesterol.
Jane also makes no mention of dairy or eggs in her restricted diet. If she was consuming these, they would contribute greatly to her cholesterol levels. Many peer reviewed medical studies have shown that a plant based diet can reduce cholesterol levels in as little as 10 days. I'm not suggesting everyone go vegan but to really give diet a shot, you need to understand the impact of the foods you eat on your cholesterol levels. All animal and fish products have cholesterol. Everyone has a choice in what they eat and becoming more educated on their food choices versus listening to marketing promises (fish oil) will help you be healthier potentially without medication. Look at the work of Cardiologist, Dr. Robert Ostfeld at Montefiore medical center in the Bronx to learn more.
6
I am anti-med for the most part, opting to eat right, exercise, etc. But like the author I reached a point of weighing pros and cons of a statin. My cholesterol numbers are around 240 for the past few years, I'm in my early 60s, and my dad died of a heart attack at 42, and two siblings each at age 50. So it's Lipitor for me, and yes I'm concerned about side effects. But I wonder, does the availability of these statins give the users "perrmission" to eat, drink, anything they want, knowing that their LDL counts will maintain at the desired levels. I've seen it with a few friends. Better living through chemistry I guess.
6
Statins work best when combined with a heart-healthy diet, and regular exercise.
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@Blue Jay: yes, but that wasn't the question -- and it is a good question.
Do statins give people "permission" to eat fatty foods and be sedentary, knowing the statin will give them "perfect numbers'?
So much of medicine today is about having "perfect numbers".
The question can be equally asked of those diabetics on drugs like metformin or insulin. The drugs/insulin give them "perfect glucose numbers"….so they continue to drink soda and eat sweets or high calorie treats with impunity.
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Thanks, good summary. Like any treatment, or medicine, or food, or activity, it's about balancing and deciding between the pros and the cons. Looking as scientifically as we are able, and then deciding based on the current best estimate of risks and benefits.
My disclosure is as a skinny physician who refuses to see drug reps in my office and does not watch TV adds, but has high genetic risk, a high calcium score, eats well, loves to exercise pretty much every day, reads medical literature daily, AND TAKES A STATIN.
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@Physician
Ms. Brody, good job.
My God, how many times does this have to be repeated -- there are choices in life. You're not going to live forever.
I, as an thinking adult, have a choice. I can *not* take statins, and perhaps *die* in my 50s, like ancestors. Or, I can take statins, and probably live into my late 70s, with some pain.
Politicians, stop "nudging" me. I'll make my decisions for myself, you clean up your messes. Thanks.
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@Physician thank you. nice to see physicians weighing in on medical issues.
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I do not think you can dismiss the muscle pain so easily. Have stopped and it goes away and restarted and it returned. CoQ10 made a difference. Exercise regularly on a rowing machine.
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My hunch is that back pain was the major medical issue that needed to be addressed in Jane Brody's case ... not her lipid profile.
I wish her very good fortune with the back pain, and hope that she will explore alternate dietary responses to her cardiovascular concerns.
She has been a reliable source of helpful information for many years, and I look forward to hearing more about her medical progress and her learning.
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A study was referenced in this article that said reported pains in muscles from statins were not real. Well, I took Atorvastatin for about 3-4 weeks, and the aching in my right knee and left ankle got so severe I could no longer sleep. It felt like toothaches! Miserable and as deplorable as Trump supporters. And there we lesser aches in other places also.
My cholesterol had been on the high side years ago, but within desired range. I began to eat better foods, including fruits, nuts, and berries, just like our bodies have evolved with for 2 million years or so. I used butter rather than margarine, ate free-range eggs 1-2 times a week, used olive oil. (Genuine, not the cheap adulterated garbage passed off in most supermarkets. Check Consumer Reports.) I quit using milk when I was weaned, as nature intended.
My cholesterol dropped way down to very respectable numbers. Over-prescribing of statins, baby aspirin, and vaccines is just to profit the pharma gangs. Look what they did with opioids! Profit when they get addicted; profit to treat their addictions. US capitalism is SICK. We're being medicated in large groups, not as individuals!!
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@Al Martin
Nobody is denying that some people get muscle pain from statins. They do. However, observationally as a physician, I found that the pain rarely began with a statin and rarely resolved when statins were stopped. Pain from other causes is much more common and is frequently blamed on the statin. OTOH, most people who start a statin do not develop pain. With the introduction of statins, we've seen a large reduction in acute myocardial infarction which is a very good pain to avoid!
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Cholestrol and its range of healthy and non healthy has been debated for years, with the first statin causing multiple deaths in the early 2000 period. This article is very poorly researched and written. Let’s get our definitions and diseases correctly identified. Plaque occurs in the arteries. And when this plaques breaks loose from an arterial wall, it travels to other arteries and blocks blood flow. This is the standard cause of a heart attack, or a lung embolism or cerebral stroke. The disease is an arterial disease and not a heart disease. Now detailed research has shown that the mechanism for plaque build up in the arteries start with an injury to the endothelial lining of the artery. When this injury is detected by the body’s defense and clean up system, white blood cells, macrophages enter the injury and ingest the damaged tissue. This is their normal function, but in an artery the become wedged between the endothelial lining and the smooth muscle wall of the artery. They are trapped and eventually they die. More macrophages enter the injury and the process continues. They get trapped and die. Over a long term, the plaque that builds up under the endothelium is the result of this repeated cycle of attempted repair. This is why calcium is found in the plaque. I did a lot of research on this subject. I have a cholesterol level at 235, zero calcium score and am 75 y.o. Lipoproteins are just a mechanism to transport lipids (oil) in an aqueous solution.
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@James T Clemens, PhD I'm curious whether you recommend that people have their calcium scores checked.
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Yes! Several doctors told me they love the calcium scoring test, after I had it performed. My doctor never recommended it, because insurance doesn’t pay for it in most cases. It cost me $100 . I took a statin and had terrible pains in my hands. Also my triglycerides rose sharply, finally convinced my doctor by plotting all the details in graphical form. Stopped statins and triglycerides returned to normal. An expert on statins is Dr. Philips, at the Mercy Hospital in northern San Diego. I sent him all my data and he told me I had the typical adverse reaction event. He has published several papers, but politics have stopped his other papers. My doctor told me recently that he diagnoses about three adverse reactions each year based on my research and experience. I asked why he does not publish the result and he told me that his medical organization would never allow it. Medicine is a big money industry and as such, the patient has to do the literature research and seek out the proper tests and, in some cases, challenge his doctor.
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@Zeke
He is not a cardiologist nor internist, much less an MD, and has no knowledge of such in practice.
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Hi Jane
If someone has been taking statins. Should they also get a calcium score. I’ve been reading that taking statins prior to taking the test can distort the score.
Thank you
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You are correct. Coronary calcium scores are helpful to make the decision but not helpful once you have been taking statins.
I elected to have a total body scan at one of those radiology for-profit practices. The scan exposes you to radiation, I know, but there is no better tool to assess the anatomical health of patient.
The scan showed I had zero coronary plaques, even though I have had high levels of LDL for decades. The radiologist advised me that I was immune to coronary blockage, and never take statins. Every doctor tries to put my on them, and I have to politely decline.
As for Alzheimers, it is increasingly being called "diabetes type 3" since the brain cells appear to be dying due to lowered glucose uptake. Some researchers are experimenting with ketogenic diets, since ketones can still be absorbed by these cells (albeit at a lower rate).
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@Borat Smith
"It is increasingly being called diabetes type 3" is a clever marketing hook used to promote the fad diet of the month. No actual Alzheimers researcher uses that term. There's no existing evidence that the "keto" diet in any of its interpretations is useful for the treatment or prevention of Alzheimers.
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@Stella B
Keton diet can also damage the liver.
@Stella B
Ketogenic diets have been used for over a century to treat neurological problems. There is current promising research into ketogenic diet as a treatment for Alzheimer's and Parkinson's diseases.
With no effective treatments for Alzheimer's, shouldn't we explore this avenue?
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Katherine
Princeton, NJ
Another potential benefit of statins may be in the treatment of age related dry macular degeneration. There was a small clinical trial done in 2016 using high dosage statins with good results . In the last year (not as part of a clinical trial, but under the supervision of a physician) I have been taking high dosage statins and have experienced a clinically demonstrated improvement in my vision.
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What about statin use and elevated levels of HDL? Per your recent column, higher HDL, especially in women, increases the risk of cardiac events. Statin use reduces my overall cholesterol, but my HDL is very high. Thoughts? Higher overall cholesterol, lower HDL?
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I spent from age 30-48 trying to control my elevated cholesterol and triglycerides as well as LDL with diet and exercise. Most of the women in my family have had elevated numbers of these (despite their diet and activity levels) so it appears to be inherited. With diet, my cholesterol hovered around 200, but triglycerides were very high and LDL was not good either. I resisted statins. At age 48 I had a total hysterectomy. I went on a strict very low fat diet (lots of veggies and fish, no meat) and lost 30 lbs in about 6 months. At that time, I had some labs done prior to an annual physical but before the date of the physical, my internist called me about t he lab results and asked me what I was eating. I proudly reported my diet and weight loss. "Well," he said, "your numbers are terrible! I guess you really needed those ovaries." That was it--total cholesterol was 330, and all the other numbers were terrible. I decided not to resist taking statins and within a month, all the numbers plummeted to the lowest numbers of my adult life. I am lucky in that I don't have side effects. I did develop Type 2 diabetes but it runs in my family-as does heart disease. Recently my doctor increased the statin and the numbers went really low. Sometimes one just has to give modern medicine its due.
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@Marlene I. Shapiro
This is the reason I have resisted a statin prescription despite a high total cholesterol: the risk of developing Type 2 diabetes.
I am glad that you wrote and I sympathize with your health journey and difficult decisions. I am glad that you feel optimistic and glad to take the medicines.
But I have known several people who developed Type 2 diabetes rather quickly after beginning a statin. This actually terrifies me and is still my main reason to resist. And heart disease absolutely runs in my family.
I think the down the road consequences of diabetes seem quite scary-eye problems, kidney problems, circulation problems and heart disease. Maybe since it runs in your family people have been good about being well controlled diabetics ? But isn't it still a pretty serious thing to live with ?
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Dear Jane, I have been following you forever. I also graduated from James Madison high school in 1959. So I’m up there also. I did the same thing you did. For. three months I stopped taking my Crestor and my back pain did not abate and also my cholesterol zoomed up to 318. I have been on a statin since 2000. First Leschol and later on in life Crestor. Much stronger. Diabetes does not run in my family yet I have developed diabetes much to my dismay. But I like you, thank heavens for Crestor and/or a Statin. Absolutely a life saving medication. Even if a doctor wanted to take me off it.... I would insist to stay on it! Be well Jane.
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why not talk about LDL-P and LDL-C, bigger, less dense LDL correlated positively with heart health. LDL=bad is oversimplification. many types of fruits, most beans and whole (or any) grains will raise weight - they are high carbohydrate. Avoid them.
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@Joe
Excess calories lead to weight gain, regardless of the source of the calories. Fruit, beans and whole grains are not particularly energy dense, and do not typically activated brain reward centers in the manner of more palatable foods like doughnuts and pizza. Therefore, these foods are not likely to contribute to excess energy intake. A plate of rice and beans (1 cup brown rice, 1/2 beans) has approximately 300 calories, in addition to substantial protein and fiber which help keep one feeling full. Add some leafy vegetables or fruit on the side, and you've got a highly nutritious meal with about 400 calories.
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@childofsol
correction: 1/2 cup beans.
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@childofsol
Very little protein, lots of starch in that meal (and missing micronutrients) compared to equivalent calories of meat/fish and leafy vegetables.
Nutritional quality feeds back on satiation, which limits subsequent calorie intake. What we eat and how much we eat are interdependent, otherwise we are left with your calorie absurdity.
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Good column. Despite being an avid exerciser for 40 years, my cholesterol has always been too high and my coronary calcium score put me at moderate risk. Nearly three years ago, my doctor suggested a statin and low- dose aspirin daily. As a result, my cholesterol, especially the bad LDL variety, dropped like a rock. My doctor described statins to me as miracle drugs in their ability to dramatically reduce heart attack risk. Incidentally, I’ve never experienced pain or any other side effect from the statin.
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@Mark Siegel
Exactly the same. Generally good diet and exercise but I tried a radical approach and barely made a difference. Did the scans and other tests to make sure it was a real risk. Finally was convinced and started taking the lowest possible dose. Also dropped like a rock and no side effects.
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@Mark Siegel
Bet you are not going to stop eating the eggs either ! Great evidence based article.
My diet has changed. An egg only every now and then. Little or no junk food. Fruits and vegetables most days. Zero sugary drinks. Etc.
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