Treating cholesterol: What are your options?

Linda, a plump middle-aged lady was distraught about her cholesterol level of 253 mg/dl, which was 53 points over the normal limit. Although she did not feel anything, she was worried about having a heart attack. A friend advised her to take a statin drug. Should she take it?

The Evidence

Simvastatin, rosuvastatin and atorvastatin belong to a class of drugs called the statins, which are very effective in lowering cholesterol levels. But first things first, does Linda really need it?

There are several guidelines for the treatment of high cholesterol. Please consult your doctor for a more intensive analysis of your risk factors. In layman’s terms, I have simplified the recommendations as follows:

• For persons with a very high total cholesterol of more than 280 mg/dl or an LDL cholesterol (the bad cholesterol type) greater than 190 mg/dl, drug treatment may be started after a) an eight-week trial of diet and exercise and b) confirmation of cholesterol levels beyond the above cut-offs.

• For those persons who have heart disease, hypertension or are heavy cigarette smokers, drug treatment is started at a much lower cholesterol level of 240 mg/dl and higher or an LDL cholesterol of more than 160 mg/dl.

• And for those who have diabetes or have already suffered a heart attack or stroke, they are the ones who would most benefit from the statin drugs, even if their cholesterol levels are just a shade over 200 mg/dl.

A landmark study called Jupiter, shows that even for patients with normal cholesterol levels, they’re still not safe. A new test called hs-CRP has been discovered. And if your hs-CRP level is high, you still can get a heart attack or a stroke.

Steps For Cholesterol Treatment

1. Check the accuracy of the test. First, cholesterol test results are notoriously inaccurate, unless the test is taken at a reputable laboratory. Second, make sure the 12-hour fasting requirement is followed — no food and just a minimum of water before testing. For these reasons, a repeat test after one to two months of diet and exercise may save the patient money and needless worry.

2. Emphasize lifestyle changes. Drugs are expensive and entail frequent monitoring for side effects. Thus, lifestyle changes should be maximized.

Concerning diet, patients are encouraged to increase their intake of fish and vegetables. Try replacing high-fat food items with low-fat options. Craving full cream milk? Try skim milk. Yearning for pork fat? Try bangus belly fat. Also, practice boiling or broiling foods as opposed to frying. Likewise, increase your fiber consumption, such as apples, legumes, and grains, since fiber removes the cholesterol from your body.

Aside from diet, exercise is very effective in lowering your bad LDL-cholesterol and increasing your good HDL-cholesterol. A general increase in physical activity is encouraged. The best exercise is still brisk walking, five times a week for about an hour.

3. Know the drug treatment options for your budget. If diet and exercise fail (meaning your cholesterol levels are still above the cut-off levels), then the best drugs around are the statins. At the high end, we have Rosuvastatin and Atorvastatin, which cost around P22 to P44 per tablet, one tablet taken daily before bedtime. Those with a tight budget can take the generic Simvastatin 20 mg.

A common question is: How long should I take statins? Studies show that statins should be taken for three to five years to reap lasting benefits. Popping a pill after eating a T-bone steak may remove the guilt but not the fat.

And for those on a really low budget, the Lancet Journal suggests taking an aspirin, which it dubbed as the “poor man’s statin.” Aspirin at 80 mg a day should be taken after meals to avoid stomach upset. Many doctors also combine statins with aspirin as these drugs have added health benefits.

4. Opt for natural treatment. For those with an aversion to drugs, there are three natural and effective options available.

• First, oatmeal and oat bran are rich in omega-3 fatty acids, magnesium, potassium, vitamin Bs, calcium, and a soluble fiber called beta glucans. These beta glucans work by interfering with the absorption and production of cholesterol. Studies show that if you eat a cup of oatmeal every day, you can reduce your cholesterol level by an average of 10%. Furthermore, Chicago cardiologist Dr. Michael Davidson adds that one-third of patients who ate more oats were spared from taking an anti-cholesterol medicine.

• Second, eat more oily fishes, like sardines, salmon, tilapia and bangus. These fishes are rich in protein and omega-3 fatty acids that help dilate the blood vessels of the heart and brain. Thus, it can improve blood flow to these vital organs. A large Japanese study showed that patients who took omega-3 fish oil supplements lowered their bad cholesterol by 26 percent and reduced their heart attack  by 19 percent. Dr. Dariush Mozaffarian from Harvard Medical School believes that taking two to three servings of fish every week already confers substantial health benefits.

• Third, eating garlic is good for the heart, too. Garlic contains allyl sulfides, which may help lower cholesterol levels. According to Dr. Robert Lin, a leading garlic researcher, taking three cloves of garlic a day can reduce your cholesterol levels by 10-15 percent. Cook garlic lightly. Don’t burn it, or else it will lose its health effects.

Presented with the above options, Linda agreed to religiously diet and exercise for two months. If she fails, then treatment with statin drugs may be considered. Good luck to Linda and all those with cholesterol problems.