Statin therapy underused for treating severe hypercholesterolemia


The number of adults with severe hypercholesterolemia prescribed general and high-intensity statins in a Kentucky health system falls below recommended guidelines, according to a study published in The American Journal of Cardiology.

Wael Eid

“Individuals with severe hypercholesterolemia have a fivefold higher long-term risk for coronary heart disease and atherosclerotic cardiovascular disease compared with individuals with average LDL-C levels,” Wael Eid, MD, an endocrinologist and lipid specialist at St. Elizabeth Physicians Regional Diabetes Center in Covington, Kentucky, the University of Kentucky College of Medicine in Lexington, the University of South Dakota Sanford School of Medicine in Sioux Falls and Alexandria University in Egypt, told Healio. “There are distinct rigorous guidelines to support aggressive treatment for severe hypercholesterolemia with high-intensity statins and other lipid-lowering therapies, if needed. However, there is a general feeling that these guidelines are not yet fully implemented. The value of this study was to assess the extent of use of these guidelines in the population we serve, to identify potential areas of gaps in care, and to be able to identify these individual patients and optimize their treatment.”

Source: Adobe Stock

Eid and colleagues conducted a cross-sectional study of every patient who had LDL cholesterol measured in the St. Elizabeth Health Care system from 2009 to April 2020. Severe hypercholesterolemia was defined as having LDL cholesterol levels of at least 190 mg/dL. Those with severe hypercholesterolemia were placed in one group (n = 19,695) while those without severe hypercholesterolemia were placed into a second group (n = 245,525).

The severe hypercholesterolemia group had a higher prevalence of hypertension and higher mean blood pressure, systolic BP, diastolic BP and cholesterol values than those with nonsevere hypercholesterolemia.

Most patients with no comorbidities in the severe hypercholesterolemia group were treated by primary care providers (43.2% to 45.7%) — who mostly prescribed low- or moderate-intensity statin therapy — whereas 3.4% to 4.4% were treated by an endocrinologist and 2.5% to 3.3% by a cardiologist.

In the severe hypercholesterolemia group, 77% were prescribed general statins and 27% high-intensity statin therapy. Of the severe hypercholesterolemia group, 83% had persistently elevated LDL cholesterol levels, and 22% of these were prescribed a high-intensity statin.

Patients with comorbidities were more likely to be prescribed statins, regardless of hypercholesterolemia severity. Adults with severe hypercholesterolemia aged 40 to 75 years (74% to 76.3%) and those older than 75 years (65.6% to 73.6%) were more likely to receive a statin prescription than those younger than 40 years (50% to 58.3%).

“There was evidence of treatment paradox where those with highest risk for CVD are not treated as aggressively as they should,” Eid said. “Less than one-third of patients with severe hypercholesterolemia are treated by high-intensity statins. Younger patients with severe hypercholesterolemia are being less aggressively treated than those who are middle-aged, even though both have high risk for CVD. Most of these patients are being cared for at primary care offices rather than specialty medicine, and that is where most of the efforts in optimizing care should be targeted.”

Eid said support is needed from quality improvement and clinical utilization departments to have initiatives for optimizing risk for patients with severe hypercholesterolemia. He added that greater awareness of severe hypercholesterolemia in primary care practices and identifying barriers for statin therapy optimization are other important issues to address.

The Ugly Side of Statins.


Story at-a-glance

  • A review of the published statin research revealed a categorical lack of evidence to support the use of statin therapy in primary prevention of heart attacks
  • Statins may actually increase cardiovascular risk in women, the young and people with diabetes
  • The cholesterol-lowering drugs are also linked to an increased risk of cataracts, memory impairment, diabetes, erectile dysfunction and over 300 adverse health effects
  • Lifestyle changes were far more effective, and safer, for primary heart attack prevention than statin drugs.
  • Statin cholesterol-lowering drugs are among the most widely prescribed drugs on the market, bringing in $20 billion a year.1 They are a top profit-maker for the pharmaceutical industry, in part due to relentless and highly successful direct-to-consumer advertising campaigns.

    Statins

    One in four Americans over the age of 45 now takes statins, typically for theprimary prevention of heart attacks and strokes. Traditionally, primaryprevention usually involves healthy lifestyle choices that support heart health, things like eating right and exercising, yet here we have millions of Americans taking pills instead.

    Has anyone unbiased stopped to find out if these drugs are really the best method for heart attack prevention? After all, as researchers noted in theOpen Journal of Endocrine and Metabolic Diseases (OJEMD):2

    “…naive indiscriminate acceptance of novel mainstream therapies is not always advisable and prudence is required in unearthing harmful, covert side effects.”

    This is precisely the task that researchers from Ireland took on by completing an objective review of Pubmed, EM-BASE and Cochrane review databases.3Their results speak volumes…

    It is beginning to dawn on some clinicians that contemporary treatments are not only failing to impact on our most prevalent diseases, but they may be causing more damage than good. A perfect example of such an issue is the statin saga.”

    The Evidence Is In: Lifestyle Trumps Statins for Primary Heart Attack Prevention

    For a drug therapy that appears to offer little by way of primary prevention, the risks were alarming. For every 10,000 people taking a statin, there were:

    • 307 extra patients with cataracts
    • 23 additional patients with acute kidney failure
    • 74 extra patients with liver dysfunction

    The landmark review revealed “a categorical lack of clinical evidence to support the use of statin therapy in primary prevention.” They also found that statins actually increase cardiovascular risk in women, the young and people with diabetes. The review also showed that statin therapy increased:

    • Muscle fatigabilty by 30% with more than 11% incidence of rhabdomyolysis (a life-threatening muscle condition) at high doses
    • Coronary artery and aortic calcification
    • Erectile dysfunction, which is 10 times more common in young men taking the lowest dose of statin.
    • Diabetes
    • Cancer

    The researchers noted:

    There is increased risk of diabetes mellitus, cataract formation, and erectile dysfunction in young statin users, all of which are alarming. Furthermore there is a significant increase in the risk of cancer and neurodegenerative disorders in the elderly plus an enhanced risk of a myriad of infectious diseases. All side effects are dose dependent and persist during treatment.

    Primary prevention clinical results provoke the possibility of not only the lack of primary cardiovascular protection by statin therapy, but highlight the very real possibility of augmented cardiovascular risk in women, patients with diabetes mellitus and the young. Statins are associated with triple the risk of coronary artery and aortic calcification.

    These findings on statins’ major adverse effects had been under-reported and the way in which they [were] withheld from the public, and even concealed, is a scientific farce.

     Cardiovascular primary prevention and regeneration programmes, through life style changes and abstaining from tobacco use have enhanced clinical efficacy and quality of life over any pharmaceutical or other conventional intervention.”

    If You Take Statins, Your Vision Could Be at Risk

    The featured review found an increased risk of cataracts with statin use, and this was supported by a new JAMA study,4 which further revealed that the risk of cataracts is increased among statin users, compared with non-users. As a main cause of low vision among the elderly, cataract is a clouding of your eye lens.

    It has previously been hypothesized that statin antioxidant effects may slowthe aging process of the lens, but the current study revealed that they, instead, raise cataract risk, again calling into question the usefulness of statins for primary prevention of heart attacks. The researchers concluded:

    The risk-benefit ratio of statin use, specifically for primary prevention, should be carefully weighed, and further studies are warranted.”

    Certain Statins May Impair Your Memory and May Even Lead to Amnesia

    Still more research revealed that rats taking the statin Pravachol (pravastatin) had impaired learning, with lower abilities to perform simple learning and memory tasks.5 This isn’t exactly news, as in 2012, the US Food and Drug Administration (FDA) announced it would be requiring additional warning labels for statins, one of which warned that statins may increase the risk of memory loss and confusion. The warnings, particularly the one for memory loss, came as the result of anecdotal reports compiled over the previous year…

    Interestingly, the animal study found no association between another statin drug, Lipitor, and impaired memory in the rats. But Dr. Duane Graveline, a medical doctor and former astronaut, has written an entire book on this very topic, titled Lipitor: Thief of Memory.

    In my interview with him, Dr. Graveline shared his powerful story about how Lipitor caused him severe global transient amnesia, which is what brought him out of retirement to investigate statins. There have been thousands of cases of transient global amnesia and other types of cognitive damage associated with statin use, reported to the FDA’s MedWatch site. It is believed that statin drugs damage your brain by creating a cholesterol deficiency.

    Insufficient cholesterol results in your brain not having the raw materials it needs to make biochemicals critical for memory and cognitive function, including coenzyme Q10 and dolichols, the latter of which carry the genetic instructions from your DNA to help create specific proteins in your body that are crucial for cognitive function, emotions and mood.

    High Cholesterol Levels May Be Protective

    Any discussion of statins would be incomplete without a discussion of cholesterol – the ‘villain’ that these drugs mercilessly lower. Many buy into the conventional belief that lower cholesterol equals a lower risk of heart disease, but this is not always the case. And, in fact, high cholesterol levels are indeed protective in some cases, whereas low cholesterol levels are very clearly linked to chronic disease. Writing in OJEMD, researchers explained:

    “Cholesterol is crucial for energy, immunity, fat metabolism, leptin, thyroid hormone activity, liver related synthesis, stress intolerance, adrenal function, sex hormone syntheses and brain function. When prescribing HMGCoA reductase inhibitors [statins] one needs to be cognizant of the fact that the body had increased its’ cholesterol as a compensatory mechanism and investigate accordingly.

    We seem to have fallen into the marketing trap and ignored the niggling side effects with regard to the HMGCoA reductase inhibitors. The only statin benefit that has actually been demonstrated is in middle-aged men with coronary heart disease. However, statins were not shown to best form of primary prevention.

    … In actual fact, high cholesterol levels have been found to be protective in elderly and heart failure patients and hypo-cholestereamic [low cholesterol] patients had higher incidence of intra-cerebral bleeds, depression and cancer. … We are observing the revealing of the utmost medical tragedy of all time. It is unprecedented that the healthcare industry has inadvertently induced life-threatening nutrient deficiency in millions of otherwise healthy people. What is even more disparaging is that not only has there been a failure to report on these negative side-effects of statins, there has actually been active discouragement to publish any negative studies on statins.”

    This is, in large part, why so many people are completely unaware that statin drugs have been directly linked to over 300 side effects,6 which include:

    Cognitive loss Neuropathy Anemia
    Acidosis Frequent fevers Cataracts
    Sexual dysfunction An increase in cancer risk Pancreatic dysfunction
    Immune system suppression Muscle problems, polyneuropathy (nerve damage in the hands and feet), and rhabdomyolysis, a serious degenerative muscle tissue condition Hepatic dysfunction. (Due to the potential increase in liver enzymes, patients must be monitored for normal liver function)

    Ask Yourself – and Your informed Physician — if You Really Need to Be Taking Statins

    I’ve long stated that the odds are very high — greater than 100 to 1 — that if you’re taking a statin, you may not even need it, as cholesterol is NOT the cause of heart disease. To further reinforce the importance of cholesterol, I want to remind you of the work of Dr. Stephanie Seneff, who works with the Weston A. Price Foundation.

    One of her theories is that cholesterol combines with sulfur to form cholesterol sulfate, and that this cholesterol sulfate helps thin your blood by serving as a reservoir for the electron donations you receive when walking barefoot on the Earth (also called grounding). She believes that, via this blood-thinning mechanism, cholesterol sulfate may provide natural protection against heart disease.

    In fact, she goes so far as to hypothesize that heart disease is likely the result of cholesterol deficiency — which of course is the complete opposite of the conventional view. So if your physician is urging you to check your total cholesterol, know that this test will tell you virtually nothing about your risk of heart disease, unless it is 330 or higher. HDL percentage is a far more potent indicator for heart disease risk. Here are the two ratios you should pay attention to:

    1. HDL/Total Cholesterol Ratio: Should ideally be above 24 percent. If below 10 percent, you have a significantly elevated risk for heart disease.
    2. Triglyceride/HDL Ratio: Should be below 2.

    Additional risk factors for heart disease include:

    • Your fasting insulin level: Any meal or snack high in carbohydrates like fructose and refined grains generates a rapid rise in blood glucose and then insulin to compensate for the rise in blood sugar. The insulin released from eating too many carbs promotes fat production and makes it more difficult for your body to shed excess weight, and excess fat, particularly around your belly, is one of the major contributors to heart disease
    • Your fasting blood sugar level: Studies have shown that people with a fasting blood sugar level of 100-125 mg/dl had a nearly 300 percent increase higher risk of having coronary heart disease than people with a level below 79 mg/dl
    • Your iron level: Iron can be a very potent oxidative stress, so if you have excess iron levels you can damage your blood vessels and increase your risk of heart disease. Ideally, you should monitor your ferritin levels and make sure they are not much above 80 ng/ml. The simplest way to lower them if they are elevated is to donate your blood. If that is not possible you can have a therapeutic phlebotomy and that will effectively eliminate the excess iron from your body

    Try This Instead for Primary Heart Attack Prevention

    Make no mistake about it, statin drugs are some of the most side effect-ridden medications on the market, and they frequently do more harm than good. Of utmost importance, statins deplete your body of CoQ10, which accounts for many of its devastating results. Therefore, if you take a statin, you MUST take supplemental CoQ10, or better, the reduced form called ubiquinol. If you are interested in optimizing your cholesterol levels (which doesn’t necessarily mean lowering them) and lowering your risk of heart disease and heart attacks, there are natural strategies available for doing so.

    • Reduce, with the plan of eliminating, grains and sugars in your diet, replacing them with mostly whole, fresh vegetable carbs and healthy fats. Also try to consume a good portion of your food raw.
    • Make sure you are getting enough high-quality, animal-based omega-3 fats, such as krill oil.
    • Other heart-healthy foods include olive oil, coconut and coconut oil, organic raw dairy products and eggs, avocados, raw nuts and seeds, and organic grass-fed meats.
    • Optimize your vitamin D levels.
    • Exercise daily, especially with high-intensity interval training (HIIT) exercises.
    • Avoid smoking or drinking alcohol excessively.
    • Be sure to get plenty of good, restorative sleep.

Cholesterol Plays Key Role in Cell Signaling.


cholesterolAre you still under the impression that cholesterol is a dietary villain and a primary cause of heart disease? And do you avoid eating healthy animal foods like eggs, butter and grass-fed beef because of “high-cholesterol” fears?

It’s time for these pervasive myths to be laid to rest, as when you understand the truth about how cholesterol works in your body you’ll realize it’s not an enemy to your health, but instead plays an essential role in keeping your body functioning optimally.

Cholesterol Crucial for Healthy Cell Functioning

Cholesterol has been demonized since the early 1950’s, following the popularization of Ancel Keys’ flawed research. As a result, people now spend tens of billions of dollars on cholesterol-reducing drugs each year, thinking they have to lower this “dangerous” molecule lest they keel over from a heart attack.

But cholesterol has many health benefits. Recent research revealed, for instance, that cholesterol plays a key role in regulating protein pathways involved in cell signaling and may also regulate other cellular processes.1

It’s already known that cholesterol plays a critical role within your cell membranes, but this new research suggests cholesterol also interacts with proteins inside your cells, adding even more importance.

Your body is composed of trillions of cells that need to interact with each other. Cholesterol is one of the molecules that allow for these interactions to take place. For example, cholesterol is the precursor to bile acids, so without sufficient amounts of cholesterol, your digestive system can be adversely affected.

It also plays an essential role in your brain, which contains about 25 percent of the cholesterol in your body. It is critical for synapse formation, i.e. the connections between your neurons, which allow you to think, learn new things, and form memories.

In fact, there’s reason to believe that low-fat diets and/or cholesterol-lowering drugs may cause or contribute to Alzheimer’s disease. Low cholesterol levels have also been linked to violent behavior, due to adverse changes in brain chemistry, particularly a reduction in serotonin activity Furthermore, you need cholesterol to produce steroid hormones, including your sex hormones. Vitamin D is also synthesized from a close relative of cholesterol: 7-dehydrocholesterol.

Considering the fact that conventional medicine has been telling us that heart disease is due to elevated cholesterol and recommends lowering cholesterol levels as much as possible, it may come as a shock to learn that having too little cholesterol is actually a verifiable risk to your health. As Chris Masterjohn, who recently received his PhD in nutritional sciences from the University of Connecticut, explained, to get an idea of the importance of cholesterol you only need to look at what happens if you don’t have it…

“If we want to understand why cholesterol is really an incredibly important molecule and is really our friend rather than our enemy, I think what we should look at is the question, ‘What happens without cholesterol?’ he says.

…[L]ook at Smith-Lemli-Opitz syndrome or SLOS, which is a symptom of genetic deficiency in cholesterol. It’s when people can’t make enough cholesterol on their own. In order to actually have this full-blown syndrome, it’s a recessive trait, which means you need a defective gene for cholesterol synthesis from your father, and you need one from your mother as well. Now, the number of people who carry this defective gene in the population is about one to three percent of the population.

However, the number of babies who are born with Smith-Lemli-Opitz syndrome is far lower than we would expect. …It turns out that if [the fetus] has both of these genes and the unborn child can’t synthesize its own cholesterol, then this usually results in spontaneous abortion. So right away we see that cholesterol is needed for life itself…”

In those rare cases where a baby is born with Smith-Lemli-Opitz syndrome, the child is susceptible to and can present a wide range of defects, such as:

Autism or mental retardation Failure to thrive Physical defects in hands, feet and/or internal organs
Visual problems Increased susceptibility to infection Digestive problems

Heart Disease May Even be Caused by a Cholesterol Deficiency

According to Dr. Stephanie Seneff:

Heart disease, I think, is a cholesterol deficiency problem, and in particular a cholesterol sulfate deficiency problem…”

Through her research, she has developed a theory in which the mechanism we call “cardiovascular disease” (of which arterial plaque is a hallmark) is actually your body’s way to compensate for not having enough cholesterol sulfate. She believes that cholesterol combines with sulfur to form cholesterol sulfate, and this cholesterol sulfate helps thin your blood by serving as a reservoir for the electron donations you receive when walking barefoot on the earth (also called grounding). She believes that, via this blood-thinning mechanism, cholesterol sulfate may provide natural protection against heart disease. In fact, she goes so far as to hypothesize that heart disease is likely the result of cholesterol deficiency — which of course is diametrically opposed to the conventional view.

Total Cholesterol Level is Not a Reliable Indicator of Your Heart Disease Risk

As the the leading causes of death in the United States, it’s important to monitor your risk factors for heart disease and make changes to your lifestyle accordingly. However, total cholesterol will tell you virtually nothing about your disease risk, unless it’s exceptionally elevated (above 330 or so, which would be suggestive of familial hypercholesterolemia, and is, in my view, about the only time a cholesterol-lowering drug would be appropriate). Two ratios that are far better indicators of heart disease risk are:

  1. Your HDL/total cholesterol ratio: HDL percentage is a very potent indicator of your heart disease risk. Just divide your HDL level by your total cholesterol. This percentage should ideally be above 24 percent. Below 10 percent, it’s a significant indicator of risk for heart disease
  2. Your triglyceride/HDL ratios: This percentage should ideally be below 2

Four additional risk factors for heart disease are:

  1. Your fasting insulin level: Any meal or snack high in carbohydrates like fructose and refined grains generates a rapid rise in blood glucose and then insulin to compensate for the rise in blood sugar. The insulin released from eating too many carbs promotes fat and makes it more difficult for your body to shed excess weight, and excess fat, particularly around your belly, is one of the major contributors to heart disease.

Your fasting insulin level can be determined by a simple, inexpensive blood test. A normal fasting blood insulin level is below 5, but ideally you’ll want it below 3. If your insulin level is higher than 3 to 5, the most effective way to optimize it is to reduce or eliminate all forms of dietary sugar, particularly fructose, from your diet.

  1. Your fasting blood sugar level: Studies have shown that people with a fasting blood sugar level of 100-125 mg/dl had a nearly 300 percent higher risk of having coronary heart disease than people with a level below 79 mg/dl.
  2. Your waist circumference: Visceral fat, the type of fat that collects around your internal organs, is a well-recognized risk factor for heart disease. The simplest way to evaluate your risk here is by simply measuring your waist circumference. For further instructions, please see my previous article, Your Waist Size Can Be a Powerful Predictor of Hypertension and Other Chronic Diseases.
  3. Your iron level: Iron can be a very potent cause of oxidative stress, so if you have excess iron levels you can damage your blood vessels and increase your risk of heart disease. Ideally, you should monitor your ferritin levels and make sure they are not much above 80 ng/ml. The simplest way to lower them if they are elevated is to donate your blood. If that is not possible you can have a therapeutic phlebotomy and that will effectively eliminate the excess iron from your body.

Do You Need to Monitor Your Dietary Cholesterol Intake?

About 80-90 percent of the cholesterol in your body is produced by your liver, which has led to the faulty assumption that cholesterol from dietary sources can, and should, be avoided. Dr. Seneff actually believes it’s difficult to get “too much” cholesterol in your diet, particularly in the standard American diet. But you may very well be getting too little, and that can cause serious problems. She points to the research by Weston A. Price, a dentist by profession who traveled all around the world studying the health effects of indigenous diets. Interestingly enough, many indigenous diets are shockingly high in dietary cholesterol based on today’s conventional medical standards.

Cholesterol-rich foods like caviar, liver and the adrenal glands of bears were highly valued in some cultures that also had very low rates of heart disease and other modern diseases.

Dr. Seneff believes, as do I, that placing an upper limit on dietary cholesterol, especially such a LOW upper limit as is now recommended, is likely causing far more harm than good. You can get an idea of what types of cholesterol-rich foods to include in your diet by following my nutrition plan. As Masterjohn further pointed out:2

“Since we cannot possibly eat enough cholesterol to use for our bodies’ daily functions, our bodies make their own. When we eat more foods rich in this compound, our bodies make less. If we deprive ourselves of foods high in cholesterol — such as eggs, butter, and liver — our body revs up its cholesterol synthesis. The end result is that, for most of us, eating foods high in cholesterol has very little impact on our blood cholesterol levels.

In seventy percent of the population, foods rich in cholesterol such as eggs cause only a subtle increase in cholesterol levels or none at all. In the other thirty percent, these foods do cause a rise in blood cholesterol levels. Despite this, research has never established any clear relationship between the consumption of dietary cholesterol and the risk for heart disease… Raising cholesterol levels is not necessarily a bad thing either.”

How to Optimize Your Cholesterol Levels Naturally

The goal of the guidelines below is not to lower your cholesterol as low as it can go, but rather to optimize your levels so they’re working in the proper balance with your body. Again, the majority of your cholesterol is produced by your liver, which is influenced by your insulin levels. Therefore, if you optimize your insulin level, you will automatically optimize your cholesterol. This is why my primary recommendations for safely regulating your cholesterol have to do with modifying your diet and lifestyle as follows:

  • Reduce, with the plan of eliminating, grains and sugars in your diet. It is vitally important to eliminate gluten-containing grains and dangerous sugars especially fructose.
  • Consume a good portion of your food raw.
  • Make sure you are getting plenty of high-quality, animal-based omega 3 fats, such as krill oil. Research suggests that as little as 500 mg of krill per day may improve your total cholesterol and triglycerides and will likely increase your HDL cholesterol.
  • Replace harmful vegetable oils and synthetic trans fats with healthful fats, such as olive oil, butter and coconut oil (remember olive oil should be used cold only, use coconut oil for cooking and baking).
  • Include fermented foods in your daily diet. This will not only optimize your intestinal microflora, which will boost your overall immunity, it will also introduce beneficial bacteria into your mouth. Poor oral health is another powerful indicator of increased heart disease risk.
  • Optimize your vitamin D levels, ideally through appropriate sun exposure as this will allow your body to also create vitamin D sulfate—another factor that may play a crucial role in preventing the formation of arterial plaque.
  • Exercise regularly. Make sure you incorporate high-intensity interval exercises, which also optimize your human growth hormone (HGH) production.
  • Avoid smoking or drinking alcohol excessively.
  • Be sure to get plenty of high-quality, restorative sleep.

Source: Dr. Mercola