August 3, 2015

House Call

I have been a vegetarian much of my life, exercise regularly, but suffered a heart attack at 52 years of age. My father died of a heart attack at 49. I have been placed on statin medications to lower my cholesterol. Recent reports indicate that these medications may be associated with an increased risk of diabetes. Should I take statins?

Your personal medical history indicates that you have strong risk factors for coronary heart disease. Family history is one of the risk factors one cannot modify or reverse. Other “fixed” risk factors include age and gender (male preponderance).

Other genetic factors increase the problem of hereditary disorders of lipid, or fat, metabolism. These may result in elevated cholesterol levels and increased arterial disease, in spite of careful dietary interventions. In such situations medications such as the statins are helpful in modifying outcomes and decreasing death from heart attacks.

Modifiable risk factors for coronary artery disease include:

  • smoking
  • hypertension (high blood pressure)
  • diabetes
  • obesity/metabolic syndrome
  • lack of physical activity
  • diet
  • stress (which, by some, is regarded as a “soft” or nonconventional risk factor)

The benefits of a plant-based diet; exercise; rest; balance; avoidance of rich, fatty, and refined foods; and maintaining a healthy body weight are wonderful. The wholistic Adventist health message has promoted this lifestyle for more than 150 years, and the scientific backing is robust. There are, however, exceptions, and you are one.

Lifestyle change and intervention remains the number-one approach to prevention of heart attacks.

Statin medications have been found to be useful in lowering cholesterol. There have also been documented side effects from these preparations, including muscle pains and liver function disturbance. In rare instances there can be severe muscle damage, with associated kidney damage. After more than 20 years of clinical trials and treatment, a good track record of safety has been established when these medications are prescribed in correct settings and for appropriate patients.

Long-term benefits include decreased heart attacks, lowered incidence of angina, and also interventions, such as stents and coronary artery bypass surgery. Wider benefits have been observed, including preservation of cognitive function in patients with, or at risk for, dementia, and decreased incidence of certain cancers. Statins also exert an anti-inflammatory effect, helping to decrease the likelihood of the breakdown of atherosclerotic plaque, which causes heart attack.

A recent population-based study has demonstrated an increased risk of type 2 diabetes by 46 percent. This is significant. Should every patient who is on a statin stop it? If you have had a previous heart attack, stroke, or stent, continue the treatment and discuss the risk-benefit ratio with your doctor.

Those taking a statin and not practicing best lifestyle practices, including exercise, a plant-based diet, and weight control, should revisit their approach. Lifestyle change and intervention remains the number-one approach to preventing heart attacks. High-risk patients need lifestyle intervention plus the statins.

We are blessed to have knowledge; we are wise if we follow sound counsel. Careful monitoring leads to excellent outcomes. Lifestyle, good health advice, and—most important—trust in God will make the difference.