By Erin Quinn
The notion that high cholesterol causes heart disease has allowed doctors to write millions of prescriptions for cholesterol-lowering drugs called statins that can reduce the risk of it. That seemingly indisputable notion has long suffered from an inconvenient fact: Half the people who have a heart attack don’t have high cholesterol. So, increasingly, doctors have flagged inflammation within the cardiovascular system as the culprit in these cases—an idea that has gained added currency from a study published late last year—and have discovered a drug that can help lower the risk of heart attacks for these folks: Lo and behold, it’s a statin.
The new research, called the JUPITER study, focused on C-reactive protein (CRP) because it is a marker of inflammation in the body. CRP levels in the blood go up whenever the body revs up the immune system. The study found that giving the statin rosuvastatin to men and women with normal levels of LDL cholesterol (the “bad” kind) but high levels of CRP (i.e., inflammation) reduced the incidence of heart attacks, stroke, and cardiovascular-related deaths by 44 percent. While this result does indeed seem “remarkable,” as the researchers say, it and the study itself raise some interesting questions.
First off, what does this new link between high CRP/inflammation and heart disease say about the millions of people currently taking statins, cholesterol drugs that include billion-dollar brands such as Crestor, Lipitor, and Zocor? Will they avoid heart disease even if their CRP levels are normal? Should everyone take statins to ward off heart disease, just in case? “I think this is the biggest myth in medicine right now,” says cardiologist Stephen Sinatra, MD, of the New England Heart & Longevity Center in Manchester, Connecticut. “Would I prescribe statins to a 60-year-old man who has high CRP levels and hardened arteries? Absolutely,” says Sinatra, “but I’m not convinced statins are worth it as a preventative measure, especially for women—the risks and side effects are just too great.”
Side effects may vary
If you believe the small-print warnings on ads for statins, the major side effect, muscle weakness and pain, occurs only rarely. The actual incidence is much higher, however, and muscle pain is a major reason why people stop taking the drugs. “Patients describe it as a general aching in their joints and muscles,” says Mark A. Moyad, MD, MPH, the Jenkins/Pokempner director of preventive and alternative medicine at the University of Michigan Medical Center in Ann Arbor. “The pain can start as soon as someone begins taking a statin—or not for several years. There’s no timeline.”
James Wright, MD, PhD, at the University of British Columbia, worries about more serious problems, including peripheral neuropathy, interstitial pneumonitis, and various cognitive and psychiatric effects. “I think we don’t really have a good handle on what’s happening there,” he says about these Alzheimer’s-like symptoms, “and some of the patients appear to have permanent effects.” For women, an elevated risk of breast cancer should be a major concern. “Along with blocking cholesterol, statins also block squalene, an antioxidant and immune system booster that is vital to preventing breast cancer,” says Sinatra, who notes that all side effects are more common in women, particularly postmenopausal women.
How low is too low?
Beyond its potential to undermine the original rationale for taking statins—that too much LDL cholesterol in the blood leads to cardiovascular disease—the JUPITER study also raises questions about the impact of lowering cholesterol levels too much. After all, every cell in the body needs LDL cholesterol to grow and repair itself, and the body uses it to produce hormones—including those governing sexual function.
In the study, the statin group’s median LDL level dropped from 108 to 55 after a year. Researchers have already linked low LDL cholesterol to Parkinson’s disease and possibly to amyotrophic lateral sclerosis (known as ALS or Lou Gehrig’s Disease), but they don’t really know the ramifications of keeping LDL levels as low as those achieved in the JUPITER study—especially for the years and even decades someone might stay on statins.
They do know that statins inhibit the synthesis of cholesterol in the brain, specifically by blocking what’s called the mevalonate pathway in the glial cells. This severely curtails the growth of new synapses and thus impedes communication between neurons—which may account for the amnesia, confusion, forgetfulness, disorientation, and dementia reported by some statin takers. Furthermore, in blocking this pathway, statins also inhibit the synthesis of other vital biochemicals, notably heart-friendly Co-Q10.
Who should you believe?
Mainstream medical doctors hailed the JUPITER study as a major scientific advance and BusinessWeek predicted a new boom in the sale of statins. But critics soon identified some serious problems. Perhaps the study’s full name made them skeptical: JUPITER stands for Justification for Use in Prevention: an Intervention Trial Evaluating Rosuvastatin. Or maybe it was the fact that the study was sponsored by AstraZenica, the company that makes Crestor (rosuvastatin). Among a number of specific issues, the critics pointed out that the much-touted 44 percent reduction in overall mortality actually represents a very small set of numbers: The placebo group did not experience significantly more deaths overall than the statin group. And, in fact, the difference between the two groups was narrowing when the study was suddenly stopped. Furthermore, the combination of low LDL cholesterol and high CRP that characterized the study subjects is very unusual—typically both are high—which means the study results aren’t readily applicable to most Americans.
Get healthy on your own
Many forward-thinking cardiologists recommend getting a CRP test (cost: $50 to $80) as part of a complete heart checkup. It and other tests will provide a more accurate assessment of your heart health than cholesterol levels alone. But don’t get complacent about your high cholesterol—most cardiologists still recommend getting your LDL level under 110 and your HDL above 50 (40 for men). Just make sure you do that with natural means before opting for a statin. A number of supplements produce the same effects as statins (see “Lower Cholesterol Without Drugs,” page 51), but the first step should be making changes to your diet (see “The Heart-Healthy Diet,” page 41) and exercise program. Give yourself three to six months to lose weight, eat better, and stress less—all things that can eliminate your need for statins completely. “This is an ongoing problem in medicine,” says Moyad, “a quick trigger to solve a problem that you could have solved with lifestyle changes. But people have to remember that statins aren’t a quick fix. They’re powerful drugs that come with unpleasant side effects and other huge risks.”
3 Ways to Get Your Number Down
Break a sweat. Endurance exercise, such as jogging or biking, is one of the best ways to lower inflammation. Heart-pumping activities also increase beneficial HDL cholesterol levels. Aim for 30 to 45 minutes of aerobic exercise five times a week.
Lose your belly. Women with waists that measure more than 35 inches (more than 40 for men) likely have high inflammation in the body, which creates higher cholesterol levels. Reduce your inflammation risk by whittling a few inches off through diet and exercise.
Quit smoking. Smoking hardens and inflames the arteries. If you’ve never smoked, don’t, and if you do—stop now. You’ll reduce inflammatory chemicals immediately.
Lower Cholesterol Without Drugs
Red yeast rice extract. This fermented food has been shown to lower cholesterol as much as a statin. Work closely with your doctor to find the right dosage.
Niacin. This form of vitamin B3 boosts HDL (“good”) cholesterol by 15 to 35 percent. It also lowers both LDL (“bad”) cholesterol and triglycerides (another heart disease–related fat in the blood).
Fish oil. With its high levels of omega-3 fatty acids, fish oil has been shown to reduce the uptake of triglycerides in the body. In fact, the American Heart Association recommends that people with high triglycerides take 2 to 4 grams of fish oil supplements daily.
Glucomanann. These vegetable fibers (from the Asian plant konjac) lower cholesterol by absorbing the bile acids in your intestines. After digestion your body pulls cholesterol from your bloodstream to replenish its store of bile acids. Take 5 to 10 grams daily.
Sytrinol. Research published in the journal Alternative Therapies found that taking this supplement daily reduced total cholesterol levels by 20 to 30 percent.
Fucothin. This metabolism booster has been found to help people lose weight, especially in the belly area. “It doesn’t lower cholesterol,” says Moyad. “But in the majority of cases, losing belly fat is naturally going to lower inflammation and blood pressure.”
Already Taking Statins?
If you’re one of millions of people on a statin drug, here are a few supplements to ease side effects and boost the drug’s benefits.
Coenzyme Q10. Commonly referred to as Co-Q10, this vitamin-like biochemical acts as an antioxidant to protect your body from damage. It provides specific benefits to the heart and muscles (and lessens the muscle pain that comes with taking statins). Since these drugs reduce the body’s ability to synthesize Co-Q10 naturally, Stephen Sinatra, MD, recommends taking 100 to 180 mg a day.
Squalene. This antioxidant and immune system booster is found in olive oil. “Researchers suspect that Spanish and Greek women who eat a Mediterranean diet get less cancer than American women because of the squalene effect,” says Sinatra. Add one to two tablespoons of olive oil to your diet each day.
Lycopene. A powerful antioxidant found in tomatoes, watermelon, pink grapefruit, and papaya, lycopene lowers inflammation levels throughout the body. Take 100 to 250 mg daily.
Turmeric. A frequent component of Indian cuisine, this potent anti-inflammatory herb also comes in supplement form. “I use it on a day-to-day basis,” says Sinatra. “I’ve been using it not only as an anti-inflammatory but also in the treatment of left ventricular hypertrophy and congestive heart failure.” Another option is the supplement Zyflamend, which is a mix of 10 different herbs, including turmeric.
About the Author
Erin Quinn is a freelance writer in Austin, Texas.