Weighing the best way to lower cholesterol

·6 min read
Peter Barkett
Peter Barkett

Summertime brings sunny days and warm weather. If you are like me, you might find yourself eating potato chips while waiting for a steak to finish on the grill and considering a bit of ice cream for dessert. What do these foods share, besides a boost in popularity during the summer? Unfortunately, cholesterol.

Many people may think that if their cholesterol tests with a number in the “normal” range, it means their risk of heart attack or stroke is low. The real story is more complicated and understanding what your own cholesterol numbers mean matters for your health. Just as you shouldn’t always drive at the top of the speed limit, say in icy or foggy conditions, most people shouldn’t allow their cholesterol to go to the limit either. When it comes to cardiovascular health, cholesterol numbers should be considered in the broader context of a patient’s other risk factors – like blood pressure, gender, age, family history, smoking history and other test results.

The conditions that make a health event like a heart attack or stroke possible take a long time to develop. They can also take a long time to treat, but it is better to intervene well before an emergency. Over many years cholesterol combines with blood pressure and other risk factors to transform your blood vessels. Fatty deposits, or plaques, begin to form on the walls of arteries and grow. If a plaque grows thick enough or ruptures, it can stop blood flow to part of the heart or brain, causing a heart attack or a stroke.

So how do you know if your cholesterol reading is telling you the whole cardiovascular story?  It is difficult to know when plaques are growing without performing invasive tests that can pose risks. Fortunately, there is another option – using risk factors to make a prediction. Between 1968 and 1990 researchers studied thousands of patients to better understand the impact of multiple risk factors like blood pressure, age, gender and total cholesterol. In 2013, researchers put together what they had learned into a predictive tool that can estimate a patient’s risk for a cardiovascular event over a 10-year period based on these risk factors. When it comes to your health there are many risks to consider. However, we have to make decisions about which ones to monitor, treat or ignore. That’s why it is important to estimate risk as accurately as possible, pay the most attention to the highest risks and take steps to protect our health.

Basing health decisions on risk factors is similar to stopping forest fires before they start. Midsummer we usually get a burn ban. The ban isn’t in response to a fire that has already happened, and it doesn’t matter if the day is cool or there was a light rain the night before. Once there has been a sustained period of hot, dry weather, the risk of an out-of-control fire is too high to take the chance of an open flame in a fire pit or at a campsite. So we take proactive measures. The same holds true in medicine. When we see enough risk factors that point to needing to control LDL cholesterol (the "bad" cholesterol), health care providers recommend an intervention to lower that risk – a statin medication.

Patients often tell me that they want to lower their cholesterol naturally, and I encourage them to do so, but I also encourage them not to ignore statins because the benefits of the medication are so consistent. Many diets, supplements and medications have been proposed as treatments for cholesterol, but statin medications have been studied for many years and found to have overwhelming evidence of dramatic benefits for lowering cardiovascular risk. Like a classic song that reappears at summer block parties year after year, statins endure as a greatest hit for cholesterol.

There are more major studies on statin medications than almost any other drug class, but three that are especially relevant to my patients who don’t have a prior history of cardiovascular disease are HPS (Heart Protection Study), HOPE-3 (Heart Outcomes Prevention Evaluation) and JUPITER (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin). All three studies followed thousands of patients who were predicted to be at higher-than-average risk for cardiovascular disease. Some of the patients were assigned to therapy with a statin medication and some of the patients were assigned to other treatments without statins. When the results were analyzed, all three studies showed lower rates of cardiovascular problems like heart attacks, strokes, and reduced blood flow in the group treated with statins. Notably, even patients with “normal” cholesterol numbers but above average cardiovascular risk saw a reduction in cardiovascular disease and the need for procedures to improve circulation.

Other, earlier studies show how important statin therapy is for treatment after cardiovascular disease, like a heart attack or stroke, has been diagnosed. At that point, healthcare providers recommend treating the known cardiovascular disease rather than trying to estimate or predict risk. But it was a revelation to discover that statins could protect patients’ health before the diagnosis of cardiovascular disease, and even when the cholesterol numbers were within normal ranges.

Each successive study has proven statins’ role in reducing cardiovascular disease, from the original studies in the 1990s that looked at patients with known cardiovascular disease to HPS published 20 years ago to very recent studies like HOPE-3. The studies confirm that statins are safe and effective in reducing cardiovascular disease, whether you have previously diagnosed cardiovascular disease or "normal" numbers but higher-than-average risk.

Medicine, like other fields that make big investments in research and development, gets very excited about the next big thing, but statins are one big thing that has proven their value over time. When it comes to radio hits, most will fade into the background over the years. Only a handful of songs will last the test of time and become perennial favorites. When it comes to cholesterol and medicine, statins are the “classic” hit; the gold standard when treatment is indicated.

As the summer nears its end, please don’t forget another “classic” – vaccines. The school year and colder weather are just around the corner. As students get back to the classroom and the rest of us spend more time indoors, healthcare providers see higher rates of infections in the community. If you’re a student, have one in your family or aren’t sure if you are up to date with recommended vaccinations, please check with your healthcare provider to see if you are due. As a health care provider, I encourage everyone to stay up to date on their vaccinations for everything from tetanus to COVID-19. Studies show again and again that vaccination lowers your risk of severe, preventable illnesses.

Peter Barkett, MD, practices internal medicine at Kaiser Permanente Silverdale. He lives in Bremerton.

This article originally appeared on Kitsap Sun: Lowering your high cholesterol