Monday, June 11, 2012

Statins -Getting more bang for your buck

Myopathy has been estimated to occur  in about 1 per 10,000 patients treated with statins . My own personal experience suggest that mild muscle aches and pains  related to statins is more frequent.

High dose = higher risk
Higher doses of Statins are associated with increased risk of muscle  and liver damage . The initial recommended dose gives the greatest reduction in LDL cholesterol , about a 27% reduction, subsequent doubling the dose results in an additional 7% reduction in LDL. This is called the rule of 7.
                                         American J. of Cardiology 1997;80:106-107
For example 2 commonly used Statins
                   zocor              Lipitor             LDL Cholesterol % reduction  
                  10 mg                5mg                   27% reduction in LDL
                  20 mg              10 mg                  34% reduction in LDL
                  40 mg              20 mg                  41% reduction in LDL
                  80mg               40 mg                  48% reduction in LDL
                                          80 mg                  55% reduction  in LDL

There is great individual variation in the effect of statins but general you get the most bang for your buck with the initial  starting dose , a 27% reduction in LDL cholesterol 
The subsequent 7% reduction attained with each doubling of the dose comes with an increasing the risk of muscle and liver damage.

There is another option .
Reduce your fat intake
Reduce the Fat intake in your diet by 25% and lower your LDL cholesterol by 5% without the    risk of muscle and liver damage
                                New Engl. J. Medicine 1993; 328: 1213-1219 Hunningshake DB et al
                                  the Efficacy of intensive diet therapy alone or combined with lovastatin

          "A reduction in  calories from fat from 40 to 20% , a 50 % reduction generally leads to approximately a 20 % reduction in LDL and total cholesterol"       
                                  Ornish D.  Can life style changes reverse coronary atherosclerosis ?  Hosp. Pract. 1991 ; 26: 123-132

Comment on food 
( little changes done over a long time work better than big changes done over a short time )

The Dean Ornish diet  , 10% fat  intake, mentioned above  was a little to difficult for most people to manage long term. However his studies were some of the first to demonstrate the power of lowering fat intake in managing and correcting  cholesterol problems.
Vegetarian diets some of recent ideas of the Mediterranean diet , Dash diet are a little easier to accomplish by gradually working them into our individual our life styles over time . You have plenty of time to make the changes , because managing cholesterol problems is a life time challenge and total reliance on a pill usually fails . See my comments on the Dash diet on May 19 post, The Dash diet my experience.

Have more fun
Spending you dollars on fruits, vegetables , whole grains and low fat dairy products is more fun than paying cardiologist and heart surgeons for their amazing skills.

The 5 % lowering of LDL cholesterol attained with a reduction in dietary fat intake is without risk  and is not much different than the 7% reduction attained by doubling the statin dose with higher risk of complications. The primary benefit gained from your  "Statin " is with the initial starting dose , a 27%  average reduction in the LDL cholesterol and then save time , you don't have to read food content labels , by shopping  in fruit and vegetable section of your grocery store.

Have fun , Be smart and eat your fruits and veggies
David Calder,MD

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Your comments and questions are appreciated. David Calder,MD