Statins for bad cholesterol

My friend, Christopher, is concerned about his consistently high cholesterol levels. His siblings and mother have the same challenge. They've all decided against using statins, a class of drugs used to treat high cholesterol - if the doctor prescribes statins they won't take them.

He sent me an article about statins, published in England's Daily Mail. It sang praises for statins but warned of possible side effects. It cautioned that "unless a person is at high risk of suffering a heart attack or stroke, statins may cause more harm than good".

Studies reported last week indicate that statins may lower the risk of prostate cancer and Alzheimer's. However, Christopher's concerns aren't unique. I've met several clients who are against the use of statins.

Cholesterol and Jamaicans

Health Editor Eulalee Thompson who published a book, Living Well recently, reports therein that one in 10 Jamaicans has a high-cholesterol problem.

Most of this waxy substance, cholesterol, is made by our liver, while some comes from our diet. Factors that promote high cholesterol levels in the blood (hyper-cholesterol-aemia), include eating too much saturated fats and trans-fats and being overweight.

In few cases, persons inherit an abnormality in the way the body handles cholesterol, producing unusually large amounts of the stuff.

The trouble with cholesterol

Cholesterol starts building in our bloodstream from childhood. It's the stuff that heart attacks and strokes are made of - when it builds up sufficiently, the surplus is deposited in the lining of our blood vessels, which may lead to blockage (a condition called atherosclerosis ensues). If we have other risk factors, which we don't control, stroke or heart attack is likely.

Cholesterol isn't all bad. In fact, cholesterol carried in the blood by high density lipo-proteins, (HDL or so-called good cholesterol) lowers the risk of heart disease and is actually beneficial to the body. It's cholesterol carried by low density lipo-proteins, (LDL or so-called bad cholesterol), which should be kept low for good health.

A good heart-attack prevention plan involves exercising regularly, eating heart-healthy foods and controlling cholesterol. Dietary changes are helpful in reducing high cholesterol levels in only few persons since most of the bad cholesterol is manufactured by the liver.

Doubts about statins

Although statins are the drugs of first choice for treating high cholesterol problems, and are proven to increase survival rates, many worry about their possible side effect of serious muscle damage (myopathy or myositis). If myopathy progresses, kidney failure can happen.

Symptoms are unexplained muscle pain, weakness, tenderness. 'Good' news is that only about one in 1,000 statin users ever suffers this side effect. Cataracts are another possible side effect.

Meet the statins

Statins include atorvastatin, fluvastatin, pravastatin, rosuvastatin, lovastatin, pitavastatin and simvastatin. Grapefruit and its juice shouldn't be consumed by statin users; they increase the blood levels of statins, increasing the risk of side effects.

Where appropriate, lowering high blood pressure, managing diabetes, and using low-dose aspirin are added strategies to lower the risk of heart attack and stroke.

Dr Dahlia McDaniel is a pharmacist with a doctorate in public health. She is the chief executive officer of two pharmacies and a medical practice in Kingston; email: yourhealth@gleanerjm.com.