The New Cholesterol Guidelines: Concerns & Considerations

scriptThis week, the American Heart Association in conjunction with the American College of Cardiology released new guidelines for cholesterol that are more aggressive in terms of the application of statin therapy. In summary, the recommendations call for the use of stratified risk factor categories to determine the prescription of cholesterol medications. If an individual falls into any one or more of these categories, they should be prescribed a statin:

  1. Existing heart disease
  2. People between 40 and 75 years of age with an estimated 10-year risk of heart disease of 7.5 percent
  3. Anyone 21 or older with an LDL level of 190 or higher
  4. Type 2 diabetics between 40 and 75 years of age

These new guidelines are aimed at staving off heart disease but are they overzealous? The new guidelines will effectively double the number of Americans eligible for statin therapy, bringing the total to about 72 million. While experts say the new guidelines include a focus on lifestyle management as well, many argue that the increased use of medications gives people a false sense of security and will not prompt individuals to make lifestyle changes such as quitting smoking, increasing physical activity, and improving their diets (all known to improve cholesterol profiles). In addition, concerns have been raised about the variety of side effects that statin drugs carry, including muscle pain and damage, increased risk of diabetes (especially for females), neurological issues, liver damage, digestive problems, and rash/flushing.

I could go into great detail over the myriad of issues that present themselves with these new guidelines, but other authorities have already chimed in on the subject. I encourage you to read their assessments here:

Don’t Give More Patients Statins

While I'm certainly not "anti-medication", (I believe in a philosophy of using whatever intervention helps improve outcomes and does the least harm) it does seem that casting a wider net that potentially doubles the number of people on statin drugs is rather extreme. What's even more disconcerting about these new guidelines is that they focus on lowering cholesterol and LDL at all costs, with no mention or specificity into the true mechanisms that contribute to heart disease and atherosclerosis (inflammation and endothelial dysfunction), or alternative options for improving cholesterol profiles that do not include statin therapy.

The Problem with Statins

If liver damage, neurological problems, muscle pain/neuropathy, diabetes, and digestive issues aren't enough to have you looking for alternative options, consider the following:

statin pathwayStatins work as HMG-CoA reductase inhibitors. HMG-CoA reductase is an enzyme within the cholesterol synthesis pathway. When you block or inhibit this enzyme with a statin, you effectively block the production of cholesterol. Sounds great right? Unfortunately there are some consequences to this action:

  1. Blocked synthesis of COQ10. Coenzyme Q10 is powerful antioxidant (the only antioxidant that humans synthesize in the body) and an essential compound that functions to help produce energy (ATP) in every cell in the body. Without getting too deep into the science, CoQ10 transports electrons along the chain within the mitochondria ("power plants" in cells) for eventual interaction with oxygen that results in massive energy production for the cell and therefore the body. When CoQ10 is not present in adequate amounts, this process is impaired, the electrons build up causing the steps before it to be impeded and not only is energy not produced, but various metabolites such as lactic acid, can accumulate. In addition, CoQ10 levels are decreased in the heart muscle of patients with heart failure, with the deficiency becoming more pronounced as heart failure severity worsens; so the very organ statins are prescribed to protect, the heart, is actually being compromised by their action against CoQ10!
  2. Blocked synthesis of dolichol. Dolichol is a compound broadly distributed in cell membranes and is also produced along the same pathway as cholesterol and COQ10. With normal, biological aging, levels of dolichol dramatically increase; however, in Alzheimer's disease, the situation is reversed with decreased levels of dolichol occurring ¹, ².

Researchers speculate that dolichol may act as a radical scavenger of peroxidized lipids belonging to the cell membranes and along with vitamin E, "these molecules might interact each-other to form a highly matched free-radical-transfer chain, whose malfunctioning might be involved in statin toxicity and neurodegenerative diseases." ³ In basic terms, dolichol, along with vitamin E, may team up as a duo of antioxidants that protect cell membranes of the brain, and that when malfunctioning or not present, may be implicated in conditions such as Alzheimer's disease.

Nutrient Depletions

Medications don't have side effects, they just have effects. All medications come with "unintended consequences" that can often be as frightening as the very thing they are trying to treat. In the case of statin drugs, not only is CoQ10 a nutrient lost by its action, but the antioxidant activity of vitamin E (we've already discussed how important it is with dolichol and the protection of cell membranes) is also indirectly affected.

Along with vitamin E, use of omega-3 fats has been shown to work both with and without statins in improving lipid profiles4. The chart below details the nutrient needs and cautions with statin use:

statin chart

As you can see, not only is CoQ10 critical for those on a statin, but particularly those with existing heart disease as outlined by the new cholesterol guidelines! If these individuals are being prescribed a statin without concomitant CoQ10 recommendations/insistence by their physician, then they could be exacerbating potential heart complications.

It's clear that there are multiple considerations when examining the use of statin drugs. I'm sure that there will continue to be arguments on both sides in terms of the new statin recommendations. The key is to consider the physiological implications, alternative solutions that harbor fewer side effects, and emphasize lifestyle modification versus simply falling even deeper into the "pop a pill" mentality that already pervades the conventional medical model.

In part two of this series on the new cholesterol guidelines, I'll be discussing a more effective and specific cholesterol panel profile demonstrated by research to provide a more distinct risk assessment for cardiovascular disease/event.



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