Should You Take Cholesterol-Lowering Medications?

one in every five deaths in the United States is from heart disease which is inexcusable given that there are so many ways to reduce our risks for some people one of those ways is to consider cholesterol lowering medications and this video aims to present to you the research from clinical studies so that you can make your own informed choice about whether these therapies are for you but it's critical to remember that blood cholesterol levels are only one risk factor of many for cardiovascular disease we still need a great diet regular exercise prioritize sleep be a healthy weight and manage insulin resistance and blood pressure this video though will focus on cholesterol lowering medications so why do we need to worry about blood cholesterol levels first of all cholesterol is essential for life we need it for our cell membranes for hormone production such as testosterone B production so that we can digest fats and the list goes on so no cholesterol equals no life but we've known for decades that all cells in our body can produce their own cholesterol and organs such as the liver can produce extra cholesterol in case other cells need a temporary top up that extra cholesterol is packaged into a vehicle called A lipoprotein and transported in the blood but problems arise when the concentration of the lipoproteins specifically lipoproteins that have got an Appo tag are too high those apob lipoproteins can become retained and trapped in our blood vessel walls leading to blockages over time but how do we know this after all there's a lot of controversy on social media regarding blood cholesterol levels well whenever there's controversy we go back to what the clinical trials show a massive study in 2017 was published in the European heart Journal it is a Metro analysis that combined over 200 separate studies including more than 2 million participants they found a remarkably consistent association between the amount of exposure to low density lipoproteins and the risk of heart disease lowdensity lipoproteins or LDL are part of the epob family of lipoproteins which I mentioned earlier and you can see the strong Association on this graph here where whether it's randomization studies prospective studies or randomized control trials there's a strong association between higher lzl cholesterol levels and the risk of heart disease the evidence is so strong that it unequivocally establishes that lowdensity lipoproteins cause heart disease now you may hear online some people saying that you don't need to worry about blood cholesterol levels so long as your other risk factors are controlled so for example if you're a healthy weight and your blood pressure is perfect and your insulin sensitive then you don't need to worry about your blood cholesterol levels however the pie of study specifically looked into this the study found that even in individuals with optimal levels for all of the other cardiovascular risk factors there was still a significant correlation between low density lipoprotein cholesterol and the presence of blockages in blood vessels and you can see this Association quite clearly on the graph so as lzl cholesterol levels increase so too does the presence of blockages in blood vessels the study reinforces was the idea that the desirable lowdensity lipoprotein cholesterol concentrations are probably much lower than those currently recommended and suggest that blockages in our blood vessels can occur if the LDL cholesterol is above 60 mg per dcil there's even a suggestion in the literature that the optimal LDL cholesterol levels are probably that of when we were born so between 20 to 40 mg per dcil but that's an incredibly aggressive Target and most people to reach those levels will need to be on a cholesterol lowering medication so instead it's probably reasonable to go by what the P of study suggested which is to aim for levels below 60 mg per deil and the earlier you reach these levels the more protected you are against heart disease so if lifestyle isn't enough to reach those levels then you may want to consider cholesterol lowering medications but is it safe to lower blood cholesterol levels to these aggressive targets after all like I mentioned at the start of the video cholesterol is essential for life but you need to remember that all cells in our body can produce their own cholesterol when we look at brain health for example there was a consensus statement by the American Heart Association they show evidence to explain that the brain does not depend on dietary or liver sources of cholesterol because it can produce its own cholesterol and we've got good evidence showing that cholesterol lowering medications do not cause neurod degeneration we've also got great evidence showing that very low LDL cholesterol levels from intensive cholesterol lowering treatments are not associated with any adverse event and just to clarify because I know this will come up in the comment section no I'm not sponsored by big farmer not only is that highly unethical but it's also illegal in New Zealand moving on what cholesterol lowering medications should we consider let's start with the ones that don't work medicine used to think that trying to raise HDL cholesterol would be protective against heart disease multiple drugs were developed and tested these drugs did result in higher HDL cholesterol levels but unfortunately they did not decrease the risk risk of heart attacks the guidelines also do not recommend fibrate therapy because they also didn't appear to reduce heart disease it's the same for high do vitamin B3 or niin the aim high trial showed that there weren't any benefits but there were increased numbers of Strokes as well as new cases of diabetes and serious disturbances in diabetic control let's move on to the medications that do work and then we'll go through supplements that may be considered for cholesterol management the first medication to consider is low hydrophilic statins for example 5 to 10 mg of Rec Statin hydrophilic means that it mixes well with water and it doesn't get into places that it shouldn't such as fat and muscle statins work by telling your liver to not produce as much cholesterol and online statins unfortunately have got quite a dirty name so let's address side effects first Statin therapy can cause muscle pains but it's quite rare about 1 to two patients out of 100 and those risks are even lower if you stick to lowd dose therapy Statin therapy does not cause cognitive impairment and it doesn't affect testosterone levels but at higher Statin doses you can sometimes see increases in liver enzyme levels and for pre-diabetic patients it can make their insulin resistance slightly worse but statins are still recommended for pre-diabetic and type 2 diabetic patients because overall it results in lower heart disease rates but I want to emphasize again lowd dose treatment because lowd dose statins they offer about 85 to9 % of the cholesterol lowering effect and you have far less chance of developing side effects in terms of benefit if 1,000 people are treated with the Statin for 5 years 18 would avoid a heart attack but here's the really cool thing that protective effect was only after 5 years and those benefits compound the longer you're on this treatment it's important to look at your lifetime risk rather than just the 5year risk the second of four medications to consider is aetam 10 mg if low do Statin aren't enough to reach your LDL cholesterol and epob targets you may consider adding aetam aetam works by telling your gut to not absorb as much cholesterol this is important because when the body digests fat bile is released into the gut and bile is rich in cholesterol so by blocking the amount of cholesterol reabsorption from the gut you can lower your blood cholesterol levels it's a very well tolerated medication and only a small minority of patients experience some tummy upset that usually resolves with time and adding aetam to low do Statin treatment is a better option than simply cranking up the Statin dose because the combination therapy lowers blood cholesterol levels more and has less side effects the third out of four medications to consider is pcsk9 Inhibitors these medications block the pcsk9 protein from breaking down your LDL receptors the result is that more of your LDL receptors work and can therefore clear out the LDL cholesterol more efficiently these medications can be highly effective for some people some research shows that these medications can lower your LDL cholesterol by up to 70% and they cut your risk of heart attacks by more than 1/3 they are usually very well tolerated but the downside is that at the moment they're incredibly expensive and you have to inject them because of the expense this type of medication is only added to lowd dose statins and aetam if the LDL targets aren't met or if there are side effects to lowd do statins which brings me onto the final medication to consider and is the new kit on the Block it's called bidic acid bidic acid is a prodrug that's activated in the liver so this means that the therapy is highly targeted to the liver and doesn't get out into other places that it shouldn't and in a study that was published last year that included patients who were intolerant to low dose statins because of Muscle side effects bodic acid reduced blood cholesterol levels and heart attacks and unlike statins which may slightly worsen insulin resistance bidic acid May improve insulin sensitivity the downside is that because bidic acid is new it's very expensive but it's possible that this type of therapy will eventually replace statins once the cost comes down moving on to supplements there are two that I want to go through and the first one is omega-3 omega-3 from the vital trial had an unexpectedly High 28% reduction in the risk of heart disease compared to Placebo and the final supplement to consider is berberine berberine works by also block the pcsk9 protein and for some people it may offer small benefits to their blood cholesterol levels and those are the only two supplements that have got some evidence for their cardiovascular protective effects as you can see we've got multiple options to lower our blood cholesterol levels in addition to lifestyle choices and this field is growing personally I Take 5 mg of Rec Statin and I may add aetam 10 Mig later on this year depending on my blood work and this video only focused on medications so if you want to hear about all of the lifestyle choices that you can make to prevent your heart attack risk make sure to check out this next video here and a massive thank you to all of the patrons who support the channel

Channel: Dr Brad Stanfield

Views: 30,422

Keywords: statin side effects, statins and cholesterol controversy, atorvastatin side effects, simvastatin side effects, statin medications, statin meds, dr berry statins, dangers of statin medications

Id: aFO4VVBhVX4

Length: 10min 10sec (610 seconds)

Published: Thu Feb 01 2024