Huge New Change in Cholesterol Guidelines — Do You Need Statins Anymore?
[Ed. note: This is Day 4 of Stephen’s special five-part series for Tomorrow in Review readers called “The Truth About MD Warnings,” in which he exposes the truth about 2014’s whacky new health recommendations and what do about them. On Jan. 26, Stephen exposed the truth about new sodium recommendations from your doctor. Should you really eat less salt? On Jan. 28, he blew the lid off a scandal in the world of sweeteners. Last Friday, he revealed a shocking connection between arthritis and red meat… Today, he navigates the controversial world of statins. Do you need them? You’re about to find out…]
For years, I refused statins.
I remember when statins became popular about 25 years ago.
I had a friend who was a cardiologist who was absolutely convinced they were the best thing to treat heart disease that had ever been invented. His sentiments echoed many others. Cardiologists love statins.
But I was never convinced they were necessary in cases where the reason was a bad diet, being overweight or not exercising.
So when my time came to decide whether or not to take a statin, I struggled for the right answer.
Sure, they proved to lower cholesterol, but Mother Nature always seems to find a way around these things.
Statins can cause liver enzymes to rise. And even if they don’t, they’re messing around with one of the most vital organs in your body — they do their work in the liver.
So I asked Dr. Philip Wolf, a co-principal investigator of the Framingham Heart Study, the longest running study ever. It began 67 years ago and is now monitoring its third generation of subjects, studying the causes of cardiovascular disease.
Based on Dr. Wolf’s knowledge, I held off on taking statins until it was absolutely necessary.
That’s because studies are showing blood pressure is the most important risk factor for heart disease — far more than cholesterol.
Influential nutritionist Dr. Frederick Stare, a longtime American Heart Association member, cited cholesterol as of minor importance as a risk factor in cardiovascular disease. And Framingham Heart Study director William Castelli demonstrated that intake of cholesterol in the diet had absolutely no correlation with heart disease.
That put a lot into perspective, so when it came to making my own personal decision, focusing on healthy blood pressure levels was my goal.
But brand-new guidelines have been released that have caused a stir in the medical community… and could change everything about how statins are prescribed.
Forget Those Cholesterol Numbers
Ever since I can remember, cholesterol has had a number attached to it. At first, your LDL (bad cholesterol) level should have been below 250.
Then no higher than 200.
Then no higher than 150. As it stands now, it should be no higher than 100, but preferably around 70.
But new guidelines say forget the numbers. Using numbers is a naive way to assess cholesterol and the risk involved.
So instead of basing a statin prescription on what number your cholesterol is, the American College of Cardiology, along with the American Heart Association, has divided the population into four new groups (stick with me here):
- People who have been clinically diagnosed with atherosclerotic cardiovascular disease (in layman’s terms, clogged arteries).
- People with LDL levels equal to, or greater than, 190.
- Diabetics aged 40-75 who have LDL levels of 70-189.
- People who have LDL levels of 70-189 who do not have a 10-year risk of atherosclerotic disease greater than 7.5%.
Based on which group you may fall into, the intensity of the statins prescribed for you will differ.
So again, what you are used to — understanding your cholesterol numbers — is out. Now it’s about risk. If you fall into one of the four groups, the goal is to lower your cholesterol by a certain percentage, not to reach a certain number.
This is a huge new change.
There is a lot of controversy over this.
Doctors got very used to having those numbers to determine how to treat a patient with cholesterol issues.
Here’s one of the problems I see: Based on the new guidelines, you could have an LDL level of 70 but are a 28-year-old who smokes and whose father died of a heart attack at age 42. You would have an incredibly high risk of heart disease and you might not fit the new guidelines to be prescribed a statin, when you really should be taking one.
The other glaring problem is with the fourth group outlined above. The guideline will result in almost everyone over the age of 65 getting a statin, because almost everyone over that age has a significant 10-year risk of getting heart disease.
Three primary risk factors lead to heart disease: age, blood pressure and smoking. Age 65 automatically kicks you into the age risk factor. Currently, there are 13 million Americans over the age of 65 who don’t take statins.
The new guidelines may be a better system, because they consider more nuanced circumstances.
But some people may be wrongly included or excluded. This is why relying on your doctor’s wisdom and participating in that discussion as a well-informed patient may be crucial.
It’s more and more evident that you have to be a far more sophisticated patient than you ever had to before, even if you’re healthy. The nuances of medicine are far greater than they used to be.
You’ve got to figure out where you fit on the spectrum of health. What’s dangerous for you and what isn’t. You don’t want to take medicines if you don’t have to. Taking 10 pills a day when it’s not necessary is not ideal and ups your chance of a dangerous reaction.
And consider this: Two nights ago, I had dinner in McLean, Virginia, with a prominent and respected physician, a woman whose cellphone number many powerful people in Washington wish they had. She is in her 60s and recently became concerned with her weight and her cholesterol levels. She wasn’t exactly overweight to my eyes. But two months ago, she went on the Ideal Protein diet, a far more complicated high-protein/low-carbohydrate diet than the other gimmicks out there. I’m not a fan of diets — you always seem to gain the weight back and more. But this doctor is convinced she can maintain her weight because she set her limit a few pounds low in case she gains some back.
She’s down to a size 2 in two months and looks fabulous and feels even better. But get this — her cholesterol is down too — way down. She told me she knew that if she weighed what she weighed when she was in college, her cholesterol levels would tumble. And she told me she’d never take a statin unless she was genetically programmed to have high cholesterol and diet and exercise couldn’t change that naturally. The best way to know what your cholesterol levels should be, she said, is to know what they were when you were 30-35, assuming you weren’t overweight then.
Good advice. And maybe it’s time to review your statin use and your cholesterol levels with your doctor again. Remember, you don’t have to stay on statins.
To a bright future,