By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
For the first time in a decade, experts from the American College of Cardiology and the American Heart Association announced new prevention and medication guidelines aimed at reducing heart attack and stroke risk related to arterial disease. The announcement made a big splash in the news media. The lifestyle guidelines contain the usual dietary recommendations: more vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, and nuts; less sugar and red meat. No surprise there. They also recommend physical activity: 40 minutes of moderate-to-vigorous activity, 3 to 4 days a week. No surprise there either. And, while the new treatment guidelines for doctors de-emphasize cholesterol numbers – a good thing in my book – they still heavily promote the use of cholesterol-lowering drugs, known as statins – not such a good thing, in my opinion.
The new guidelines call for more people to be taking statins to avoid heart disease and stroke. Whereas before, cholesterol numbers based on blood tests were the sole criteria for many doctors prescribing (over-prescribing is a better term) statins, the emphasis now is supposedly going to be less on those numbers than on an overall evaluation of risk factors, that includes smoking, weight, blood pressure, exercise level, diet, blood sugar, as well as the cholesterol numbers. If the doctor’s assessment, based on new evaluation methods, concludes that statins would provide benefit, than he or she will discuss a statin prescription with the patient. The prevention guideline emphasis still revolves on statins and the pharmacological approach, which for me is highly problematic and risky, as I described in great detail in my latest book The Great Cholesterol Myth.
First of all, statins should not be used for primary prevention. They cause depletion, among other things, of CoQ10, a natural antioxidant in the body that is absolutely essential for cellular energy production. CoQ10-related side effects of statins are underreported by doctors, and they include muscle pain, fatigue, and memory deficits.
The guidelines also lump men and women together. The research data does not show that the use of statins for women outweigh the risks, including breast cancer and diabetes.
Another problem is for individuals with diabetes. Statins have the potential to contribute to type 2 diabetes to a degree that in 2012 the FDA mandated statin manufacturers to place a diabetes warning on their labels. Moreover, there is evidence that these drugs can produce arterial calcification in diabetic men, and perhaps also increase the risk of cataracts.
Statins are already overused in the population. A quarter of Americans over 40 are on statin prescriptions! Under the new guidelines, doctors won’t be looking to lower cholesterol levels to specific numerical targets. Just taking a certain dose will be enough. That’s a real turn-off for me. One-size-fits-all medication for a drug with big side-effects? That’s not smart medicine.
What the New Guidelines Mean to You
While there’s nothing really new in the new “official” lifestyle prevention guidelines, lifestyle is nonetheless where you need to put your personal cardiovascular prevention emphasis. Please check out my prevention tips that I have recommended to patients for decades. They work great for you if you put them to work.
I stand firm by my opinion that statins should be prescribed only to men and women with advanced cardiovascular disease, and who do not have diabetes, and individuals with genetically-based high LDL cholesterol that can hasten coronary artery disease. For these people, the benefits outweigh the risks, but it is mostly for the therapeutic anti-inflammatory value of statins and not any cholesterol-lowering effect.
- Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk,
Journal of the American College of Cardiology (2013), doi: 10.1016/j.jacc.2013.11.003.
- Kolata, Gina. “Experts Reshape Treatment Guide for Cholesterol.” NYTimes, Nov. 12, 2013.
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