Q: I'm 51 and just through menopause. My cholesterol is a bit high at 235, and although I work out and my heart seems fine, my doctor says I should take a statin drug to prevent cardiovascular problems. I've heard that cholesterol-lowering statins create problematic side effects. How do I decide what's right for me?-M.E., Sitka, Alaska
A: My response to this very important question may strike some as brash. I urge all of you to examine the available data and decide for yourselves. Also, you must consider your genetic (family history) risk factor for early (before age 65) cardiovascular disease or death, your dietary and exercise habits, and your own personal history with heart and lung problems.
Cholesterol, an essential substance for health, is part of several vital biochemical processes, including the production of hormones and a healthy inflammatory response. Cholesterol is a lipid (i.e., a fat molecule) and all hormones are lipids. Progesterone, testosterone, cortisol, estrogen, and other hormones, are derived from cholesterol.
It is completely normal for a menopausal woman's cholesterol to drift up 50 points or so-the ovaries are producing no progesterone and much less estrogen. In turn, the brain sends a message to the liver, telling it to make more cholesterol. In fact, if a menopausal woman's cholesterol does not drift upwards, I get concerned about her liver function.
Statin Side Effects
You may produce more cholesterol if you are of Northern ethnic descent. Scandinavians, for example, generally have much higher total cholesterol than Africans, because of historically needing to shore up body fat over the long winter.
A double layer of cholesterol surrounds every cell in your body. This lipid layer protects the nucleus of the cell from getting "dinged." Cancer is initiated by "hits" on the nuclei of cells. This is why people taking statins are more likely to die from all types of cancer. This has been particularly well established with esophageal cancer. The May 2010 issue of the British Medical Journal published research linking statin use with cataracts and kidney failure. Further, it is well documented that people on statins are more likely to develop diabetes and dementia (see the highly referenced book by Jon Abramson, MD, Overdosed in America). Brain fog is almost as common a side effect from taking a statin drug as are muscle aches and muscle wasting.
Statins work by inhibiting a critical enzyme (HMG-CoA reductase), which is key to cholesterol production in the liver, as well as CoQ10 production. CoQ10 is an important cellular oxygenator and a vital supplement, particularly if you are still taking a statin.
New Tests for Heart Disease and Stroke
Instead of focusing on cholesterol, which is poorly correlated with cardiovascular risk, other medical parameters and laboratory results may provide incentive to clean up your act. Namely, hs-CRP (or highly sensitive C-reactive protein) is much more strongly affiliated than cholesterol, or even lipoprotein A, with cardiovascular disease. Ideally, the CRP number (a marker for inflammation) should be below 2. Most MDs are satisfied with CRP under 3. Coronary artery calcium score (CAC) is another new measure of calcium build-up (an element of plaque), which some cardiologists and internists (and NDs) now offer for risk assessment.
If you have high cholesterol (closer to 300) and a family history of cardiovascular mortality, consider getting an ultrasound of your carotid doppler, the major artery leading from the heart to the brain. The thickness of the inner wall of this artery should be less than 1 mm. If it is thicker than 1 mm, this generally means the beginning of plaque formation, which leads to narrowing of the artery and reduced blood flow to the brain. Only in this scenario might a statin-short term while you clean up your diet-help to reduce plaque. Personally, however, I'd opt for chelation therapy, which can be done through a holistic practitioner or naturopathic physician. [Editor's note: see naturopathic.org to find a doctor in your area who performs chelation.]
More Important than Cholesterol Control
Just because your total cholesterol is over 200 (an arbitrary and low-side number), do not assume you are at higher risk for cardiovascular disease. Think of cholesterol as a liquid bandage. When the lining of arteries become damaged (from debris in the bloodstream, often undigested food or indigestible metals or plastics), cholesterol gathers on the roughed-up artery wall in an attempt to smooth the damage. If you don't address the real problem-insufficient nutrients to repair the day-to-day damage to the artery walls-the artery wall won't heal, and the cholesterol starts to become thicker layers. That's how plaque starts.
The problem is not cholesterol, per se. It's damaged artery walls because you're not eating enough phytonutrients, notably vitamins C and D, magnesium, zinc, selenium, and the broad range of healing pigments: chlorophyll, bioflavonoids, lycopene, and anthocyanadins. This is why a diet rich in fruits and vegetables is essential. These pigments are the basis for tissue and cell repair. The best way to reduce cardiovascular risk is to prevent irritation and then inflammation in the heart and vascular tissues. Eat your fruits and veggies, and avoid fried foods assiduously. Minimize alcohol and don't smoke.
The Bottom Line?
Cholesterol is not "bad." It is absolutely essential to human health. If you examine the data, there is no compelling evidence that statins help prevent cardiovascular disease, with the exception of older clinical trials suggesting a benefit for men under 65 who already had a heart attack. This is known, somewhat deceptively, as "secondary benefit." No evidence of primary or direct benefit from statins exists at all. Period. In particular, there is no evidence that statins improve cardiovascular risk in women.
The emphasis among many cardiologists and MDs on pharmaceuticals for cardiovascular disease "prevention" is actually undermining efforts toward patient education of much more powerful preventive parameters: namely, getting regular physical activity, not smoking, and a following a Mediterranean-style diet. Follow the money. There's no money in "cure." The money is in drugs. Especially drugs that people take for the rest of their not-so-healthy lives.