Pass the statins—but don’t forget exercise and a healthy diet

       For almost a year, you’ve followed a diet low in saturated fat and cholesterol. You’re exercising regularly, and you’ve even lost a few pounds. But your doctor tells you that your LDL, or bad, cholesterol is still too high, putting you at risk for heart disease and stroke. He or she recommends you consider taking statins, a class of powerful cholesterol-lowering drugs. Why?

Why statins?
      Statins help fight stubborn high cholesterol in several ways. First, they slow the production of LDL, which forms fatty plaques in artery walls, thus restricting blood flow to the heart. Second, they increase the liver’s ability to remove LDL already in the blood. Statins also lower elevated triglyceride levels and slightly raise HDL, or good, cholesterol.
      According to revised guidelines issued in 2004 by the National Cholesterol Education Program, you may need drug therapy if:
      • you have an LDL level of 190 milligrams per deciliter (mg/dL) or higher with one or no heart disease risk factors
      • you have an LDL level of 160 mg/dL or higher, two or more risk factors and less than a 10 percent risk of having a heart attack in the next 10 years
      • you have an LDL level of 130 mg/dL or higher, two or more risk factors and a 10 percent to 20 percent risk of having a heart attack in the next 10 years
      When diet and exercise alone aren’t enough to lower LDL, statins may offer the needed push to get your cholesterol back on track. However, statin drugs may not be for everyone who meets the above guidelines. Before suggesting medicine, your doctor will consider several factors, such as your age, gender and blood pressure level, to determine if statin drugs are right for you.
      On the other hand, your doctor may advise you to take statins if you are a smoker or considered at high risk despite normal cholesterol levels, such as if you have heart disease, diabetes or metabolic syndrome (a cluster of heart disease risk factors, including low HDL, high triglycerides and obesity).

Taking statins
      You’ll need to see your doctor to have your cholesterol levels checked about two months after you begin taking statins. If the results are unsatisfactory, your doctor may increase your dosage or combine statins with another drug.
      Statins are generally well tolerated, but they may produce side effects such as nausea, diarrhea, constipation and muscle aches. These tend to be mild to moderate and disappear as your body adjusts to the medicine. More severe (and less frequent) side effects include liver changes, and the muscle disorder myopathy, which can lead to impaired kidney function. Close monitoring by your doctor during treatment helps avoid these, so be sure to keep your scheduled appointments.

Lifestyle counts, too!
      If you begin taking statins to lower high cholesterol, don’t neglect the lifestyle changes that can ensure your good health. Continue to exercise and eat a cholesterol-lowering diet, lose weight if you need to, quit smoking and control other heart disease risk factors such as high blood pressure and diabetes.

The numbers you want
      Experts say adults should generally aim for these cholesterol levels to reduce their risk of heart disease:
Total: Less than 200 mg/dL
LDL: Less than 130 mg/dL*
HDL: 60 mg/dL or higher
*LDL goals for those at high risk should be 100 mg/dL or less. For those at very high risk or who already have heart disease, an LDL of 70 mg/dL or less may be recommended.

Hold the grapefruit juice!
      Chemicals in grapefruit may interact with some statins, causing higher levels of the drug in your blood and increasing your risk for side effects.