Statins - who needs them anyways?

Jacob I'm a consultant cardiologist in York and today I wanted to talk about statins now this is a subject that a lot of people have asked me to do a video on because a lot of people are either taking or are told to take statins and there's a little bit of confusion um around as to who should take them and what they actually do so the first thing to say is that when you're looking at people with heart disease or people who are at risk of heart disease the way heart disease happens is that the blood vessels that supply blood to the vital organs I.E the brain or the heart can get narrowed and they often get narrowed because there's deposition of fat and that causes the arteries to harden and narrow and eventually if they're narrowed to the extent that blood can't actually get through the narrowing to the or to the heart or sometimes or to the brain then that can cause damage and that leads to either a heart attack if the blood can't get to the heart or a stroke which is like a brain attack because blood can't get to the brain so cholesterol is um a a compound found in your body uh the which in high levels can cause it can be deposited in um the blood vessels the arteries and that causes that causes a fatty plaque to develop in the blood vessels so cholesterol is um something which is normal we all need some cholesterol but in excessive quantities it can deposit there and it can cause buildup of plaque which in the long run can cause obstruction to blood flow so the first thing to say is that a lot of people have been targeting cholesterol and saying well you know if you can lower your cholesterol if it can reduce your cholesterol then you reduce your risks of developing heart attacks or Strokes um now one of the agents there are lots of agents that can reduce cholesterol but one of the agents that can reduce cholesterol are cold statins and statins are very popular and commonly prescribed because there have been lots of studies which have been shown that if you have established heart disease if you already have some buildup of plaque then reducing your cholesterol levels or taking a Statin can improve your prognosis in the long run now a lot of people ask me should everyone be on statins and the answer is this to my mind there are two sets of people who need settings okay some people there's this common misconception that cholesterol is all about what you eat you know a lot of people come to me and say oh my cholesterol is six but I eat really healthy it's true um it can be it can be because of what you eat but also there can be some people who actually have uh who cannot break the cholesterol down so they have an inherited uh uh Gene defect which means that they can't break the cholesterol down and these people are people who are familiar hypercholesterolemia so it's always worth having your cholesterol checked because it may not be because you're not eating healthy you may be eating very healthy but you may have this defect in your genes and therefore you can't break down your cholesterol and particularly if you have a strong family history of heart disease then it's always worth getting you cholesterol checked okay because it could be this thing called the familial hypercholesterolemia and if you have a familial hypercholesterolemia then there is no doubt in my mind that you should have your cholesterol reduced by medications if you don't have familiar hypercholesterolemia I your cholesterol is not unduly high you don't have a significant family history of heart disease then you don't need cholesterol lowering tablets you can do this just by a lifestyle and lifestyle doesn't just mean eating healthy it means sure you eat you know less chocolate less cake all that kind of stuff but also paying attention to eating less supermarket food which has got lots of preservatives which has got lots of additives um getting regular exercise getting lots of good sleep and those all contribute to keeping you healthy so if you have familial hypercholesterolemia if you have a deficiency in an enzyme which breaks down your cholesterol I would strongly recommend that you take a cholesterol lowering agent because although the cholesterol lowering agent is not going to do anything in the short term in the long term it can reduce the likelihood of cholesterol building up in your arteries and therefore reduce your risk of having heart attacks or Strokes the other group of patients who should have cholesterol layering tablets are people who have established a disease so in whose arteries there is already evidence of deposition of fatty block all right in those people I think it is really important that you take a Statin why for lots of reasons people think it's all about cholesterol you know the lower your cholesterol uh the better it is it is a little bit about the number lowering the cholesterol but also statins have other effects which I'm going to talk to you about which would be very beneficial in people who have vascular disease so let's try and work out the mechanism by which heart attacks occur if you have some buildup of uh plaque in your heart arteries there are two mechanisms okay the first mechanism is you get a layer of plaque and if you don't do anything about it if you keep leading a bad lifestyle if you keep smoking if you don't pay attention to your cholesterol that will progressively get worse over a period of time eventually it'll cause a significant narrowing and you will start getting symptoms of a reduction in the blood supply to the heart so you will start getting symptoms of chest discomfort on physical exertion because when you're exerting yourself you're asking for more blood and the blood can't get through the narrowing quick enough and people will often then say I walk a certain distance I get a discomfort in my chest um and then when I stop the discomfort goes away that is classical angina okay and that is caused by Progressive buildup of plaque in the heart arteries and so taking a cholesterol-lowering tablet will reduce the chances of progression of buildup of pluck in the heart arteries then there is another group of patients who may have a little bit of plaque who have no symptoms but then suddenly drop down dead because of a heart attack or suddenly have a heart attack with no warning out of the blue and the majority of people who have heart attacks do have heart attacks because there is no warning because if you had the previous situation where you had a gradual Builder you'd get a warning and you would then go to a hospital and say look I'm having this problem someone would check you out and they would find that what the problem is and they would either put a stent in or do a bypass sorry I've got the flute now the the worst scenario is where you may have a patient who um has no warning whatsoever so they may have a little bit of build up but what tends to happen is that plaque can be unstable and what makes it unstable the amount of inflammation your body is under so the amount of stress the amount of sort of whether you smoke um and that inflammation can cause the plot to rupture and when that plaque ruptures immediately what happens is the body thinks you've sustained a wound and forms a blood clot within a few seconds or a few minutes and that blood clot inadvertently blocks off the supply to the heart causing the heart muscle to die and that's what a heart attack that's how a heart attack happens so in those people what we have found is that statins have an anti-inflammatory role they have a plaque stabilization role I.E they taste plugs which are hot and therefore more likely to rupture and they make them they cool them down and make them less likely to rupture and they also have a very potent anti-inflammatory effect because we know that the majority of the majority of times it's some form of inflammation which causes the plot to rupture so statins and this is not true for all cholesterol layering and tablets it's true for statins however statins can uh stabilize block and have an anti-inflammatory role so those are the two sets of people I think should have settings people who have a familial problem whereby they can't break down their cholesterol and therefore you should treat the cholesterol aggressively and people who have established vascular disease now you may say to me well how do I know I have established vascular disease until recently we used to do this by working out your risk so if you had diabetes if you had high blood pressure if you'd previously had a heart attack or angina then we would be poorly confident that you'd have some vascular disease and people would therefore recommend the Statin now we have better technology so you can do something called CT coronary angiography you can look at your heart arteries particularly study the walls of the heart arteries and if your heart arteries are clean as a whistle then you do not need a Statin but if your heart arteries show any wear and tear any smaller amount of probably a good idea to be on statins it's important to realize that when you take statins you're taking them for Life number one it's not a case of you can take them for a few days and then discontinue them you take them for Life the second thing to realize is that whenever you're given a tablet you have to ask yourself is it going to make me feel better or is it going to make me live longer statins will not make you feel better in fact they could actually make you feel worse because they are often associated with side effects and at least five to ten percent of patients complain of muscle aches and pains when they take statins and some of them actually have to come off the Statin so statins will not make you feel better but in the long run there they can be beneficial in those two groups of patients in the very elderly patients a lot of whom have vascular disease you have to ask do they need statins well the question really is you know how much benefits are you gonna gain in a in a person who's very elderly in terms of lengthening lifespan because as a person gets older say a person is 85 lengthening their lifestyle and what you can do to lengthen their lifespan gets less and less and therefore their quality of life becomes more important so I would certainly not give a Statin if it's making someone's quality of life worse particularly in that age group because I don't think that the Statin will have that much of a benefit in terms of their lifespan you know in terms of improving their lifespan uh the other thing just to bear in mind is that all these things are fine statins maybe you know they've been hailed as this miracle thing but actually just paying attention to your diet avoiding processed food making sure you're getting enough magnesium in your diet because magnesium has an anti-inflammatory role as well and magnesium has effects of cholesterol as well so playing paying attention to your magnesium is really important getting lots of regular exercises really important one because it's anti-inflammatory two because it'll tell you if there's a problem because the first time you'll notice a problem is during exercise and three getting good sleep and number four obviously having a healthy mindset not getting unduly stressed trying to keep life simple those are the important things if you do those you don't need to rely on these tablets on extra medications to um to try and work on your risk I.E avoid getting heart disease in the first place rather than relying on medications to try and mask it once you've already developed it so I hope this was helpful and I look forward to hearing what you guys have to say about this um it's Christmas time so I wish you a very happy Christmas and I'll keep in touch you can um now get in touch with me on Facebook so they've changed my Facebook page previously it was your Cardiology now I think you have to type in my email address and it'll take you to my Facebook page um I'm also on Twitter and I have a website and this is probably the best way to get in touch with me um and I look forward to hearing from you thank you so much bye

Channel: York Cardiology

Views: 337,082

Keywords: #hangoutsonair, Hangouts On Air, #hoa, statins, cholesterol, heart disease, atherosclerosis, heart attacks, health, yorkcardiology, sanjay gupta

Id: EIqJhvuQgUU

Length: 13min 19sec (799 seconds)

Published: Wed Dec 23 2015