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Doctors Miss This When Discussing Statins | Cholesterol + Heart Disease

High cholesterol remains an ever-present issue in the U.S., but conventional health markers–such as total and LDL cholesterol levels–aren't always accurate predictors of cardiovascular risk. This also means that a statin is likely not the best choice for every patient with high cholesterol. In fact, the most common underlying causes of lipid dysregulation are often overlooked by traditional medicine.

In this blog post, we will discuss how integrative medicine approaches high cholesterol, new cholesterol screening options, and how your doctor can determine if a statin is beneficial in lowering your high cholesterol.

The Integrative Medicine Approach to High Cholesterol

The integrative medicine approach to high cholesterol focuses on identifying and addressing the underlying causes of the condition. Rather than seeing high cholesterol as a disease itself, a functional practitioner will see it as a symptom of an underlying problem.

Holistic cholesterol management involves cholesterol tests, including lipid profiles, and possible genetic testing. Recommendations to lower your cholesterol often include eating a balanced diet, maintaining a healthy weight, supplements, herbs, or other therapies. In some cases, your doctor may also recommend a statin to help lower cholesterol.

An integrative doctor will also advise you about other risk factors which can negatively impact heart health, such as high blood pressure, high stress, underlying infections, and poor gut health.

The goal is to find a treatment plan that is tailored specifically for each person.

Read more: The Truth About Cholesterol + 4 Ways to Lower Yours Naturally 

Cholesterol screenings may be too simplistic

Conventional health markers, such as total and LDL cholesterol levels, aren't always accurate predictors of cardiovascular risk. But there are other tests that offer a more complete picture.

Normally, you'll see the following when measuring cholesterol levels:

  • High-density lipoprotein (HDL) - “good cholesterol”
  • Low-density lipoprotein (LDL) -“bad cholesterol”
  • Total cholesterol
  • LDL to HDL ratio
  • Triglycerides
  • Very low-density lipoprotein cholesterol (VLDL)

New research shows that the above measurements of cholesterol levels may be too simplistic. Historically, risk assessment primarily emphasizes total cholesterol, triglycerides, and LDL.

In terms of what we once thought of as "bad" cholesterol, research is showing that particle size and subtypes are more predictive of cardiovascular health, and can better help doctors to determine whether statins are the right choice for certain people (1).

If you're one of many people who are concerned about high cholesterol levels or want to be proactive about your heart health, two other test may be beneficial:

Lipoprotein particle profile (LPP) - In addition to all the standard measurements, the LPP test also provides

  • Lipoprotein Fractionation 
  • Lipoprotein Particle Numbers
  • hs-CRP
  • Homocysteine
  • Apolipoprotein A-1
  • Apolipoprotein B
  • Lipoprotein (a)
  • Insulin

Vertical auto profile (VAP)- This test measures additional lipoprotein classes, such as Lp(a), IDL, and subclasses of "good" HDL cholesterol, LDL, and VLDL. It can identify risk factors for cardiovascular disease that cannot be identified using the standard lipid panel (2). 

Read: Holistic Cholesterol Management | Foods, Supplements, Testing

What we measure is important

Usually, doctors view more LDL cholesterol as bad, especially if total cholesterol is also high. But what likely paints a more complete picture is assessing LDL particle number, HDL particle number, and lipoprotein(a) (3,4). These numbers give a much more thorough view of your overall risk.

The ratio of total cholesterol to HDL cholesterol is a better predictor than is total cholesterol alone or LDL cholesterol alone. LDL particle number, as well as a subtype of LDL, called lipoprotein(a), or Lp(a) also provide greater insight than the standard lipid tests. Some studies suggest that Lp(a) may be the most predictive for future risk of CVD or stroke (5).

Related: Go Beyond LDL to Reduce Your Risk of Heart Disease

Want to learn more?

What Causes High Cholesterol?

The next step in determining whether a statin may be beneficial is to address the underlying issues resulting in high cholesterol.

In the U.S., much of the blame toward high cholesterol is placed upon the intake of saturated fat, animal fats, and red meat. So much so, that the true risk factors for healthy lipid levels are overlooked. Truthfully, every patient’s situation is different.

In functional medicine, high cholesterol is not considered a disease, but a symptom. Determining what it is a symptom of can be complex. Your doctor may start by evaluating the most common:

  • Thyroid issues – Your body’s thyroid hormone helps your liver remove cholesterol from your system that is not needed. Even subclinical hypothyroidism can slow this process, leading to a buildup of blood cholesterol (6).
  • Metabolic dysfunction (type 2 diabetes, NAFLD, etc.) – Any dysfunction in metabolic health can change the way your body uses and breaks down cholesterol, often leading to high cholesterol levels. Type 2 diabetes increases the risks for cardiovascular disease, as does non-alcoholic fatty liver disease, which affects nearly 1 in 4 people in the U.S (7).
  • Gut function & dysbiosis – The intestinal microbiome alters lipid metabolism and cholesterol levels at a much greater significance than previously thought. Metabolites like short-chain fatty acids, bile acids, and TMAO play critical roles in regulating heart health, and if dysregulated, can contribute to CVD (8).
  • Toxins, heavy metals, or infections – H. pylori, or exposure to lead, mercury, or others can increase cholesterol levels.
  • Genetics – Familial hypercholesterolemia is a genetic disorder that affects about 1 in 250 people and increases the likelihood of having coronary heart disease at a younger age. It can also cause “bad” LDL cholesterol to be very high (9).

Related: The Lab Tests You Actually Need

In a conventional medicine, most doctors diagnose high cholesterol and recommend or prescribe a drug to lower it. If other cardiometabolic problems are present–such as hypertension or insulin resistance–the conventional approach is generally to manage issues separately.

This approach, while it can be effective, leaves much opportunity for improvement in terms of treating a patient as a whole.

Familial hypercholesterolaemia

People who have familial hypercholesterolaemia (FH) are more likely to develop cardiovascular disease. With FH, blood tests may show a high level of total cholesterol, a high LDL level, and normal triglyceride levels (9). If you have a family history of early heart attacks, or one or both parents have high LDL cholesterol, your doctor can perform tests to determine if you have a genetic component in your high cholesterol.

With a genetic predisposition to high cholesterol, it’s important not to also exclude other factors. If you have FH, a comprehensive workup may still show other underlying factors related to lipid metabolism such as an underactive thyroid, microbiome dysbiosis, and slow detoxification of heavy metals like mercury. These may all play a role in the effects of a genetic predisposition to high cholesterol.

You might also like: Men: How to Approach Your 6 Most Common Health Problems

Do statins reduce everyone’s risk of cardiovascular health problems?

Statins are medications that work to lower cholesterol by blocking an enzyme in the liver that is necessary for making cholesterol. Statins have been shown to be effective at reducing heart attacks and strokes, but there are some risks associated with their use–and these benefits aren’t as straightforward as they seem.

In a large meta-analysis from The Lancet in 2010 summarized that all-cause mortality (not just cardio-related death) is reduced with statin treatment by 10% each year proportional to reduction in LDL (10). This sounds pretty significant, and would seem to offer a great benefit to many people.

However, the author’s interpretation of the results vs. the actual results is key here. The tables show the number of deaths decreased from 2.3 percent to 2.1 percent with reduction in LDL. That’s an overall risk reduction of less than one percent–0.2% to be exact. Not 10 percent. The cardio-related deaths across all 26 studies in the meta-analysis decreased from 1.3 percent (per year) to 1.2 percent when treating high cholesterol with a statin (11).

Statins are effective to decrease levels of cholesterol in the blood, but they may not be the appropriate treatment for all patients who want to lower their cholesterol. Statins are often accompanied by several side effects which need to be properly discussed with your doctor.

Read more: Berberine for Metabolic Health, Weight Loss, Heart Health

Statin research focuses mainly on men, and studies show statins aren’t as effective for women

There is some evidence that statins may be less effective in women than men. In addition, statins can cause some side effects that are particularly harmful for women, such as increased risk of diabetes and memory loss. Therefore, statins may not be the best option for women who are looking to reduce their risk of cardiovascular events.

For the prevention of cardiovascular diseases, the effects of statins have been mixed in their results. One meta-analysis showed that statins reduced the risk of all cardiovascular events in women, but it didn’t impact strokes, or whether or not they died from CVD (12).

Another meta-analysis looked at 18 prevention trials, and found that statins did benefit women in terms of cardiovascular events and death from all causes (13).

Read: Easy Tips for a Healthy Heart

The Side Effects of Statin Drugs

The most common side effects of statins include muscle pain, weakness, and cramps. Some people also experience cognitive problems, such as memory loss, and some types of statins increase the risk of diabetes (14).

According to one study, “statins have been associated with mitochondrial dysfunction associated with a reduction in co-enzyme Q10 levels” and this may account for the majority of muscle-related side effects, such as myalgia (14).

Shop CoQ10 for heart and mitochondria function.

Is there an effective alternative to statin treatment?

So what if you are at risk for heart disease and you’d prefer not to take a statin? There are many clinically proven ways to lower cholesterol levels naturally–even if you have a family history of heart issues–by adjusting your diet and lifestyle.

In fact, the INTERHEART study, which looked at the incidence of heart attacks in every inhabited continent in the world (in 52 countries), found that most risk factors include modifiable dietary and lifestyle actions.

Related: 5 Foods to Improve Heart Health

How can I lower my cholesterol level?

The first thing you should do to promote healthy cholesterol levels is eat well. You should avoid fried and ultra-processed foods. You should also avoid smoking and drinking to excess, and find a way to move your body that you enjoy and can participate in regularly.

Even if you have a genetic predisposition to high cholesterol levels, living a heart healthy life can still dramatically influence your lipid metabolism for the better.

How to Live a Heart-Healthy Lifestyle

The classic heart-healthy diet encourages an intake of industrial vegetable and seed oils and nutrient-poor grains, while decreasing intake of nutrient-dense foods like red meat, and other dietary sources of cholesterol.

An modern, evidence-based approach to heart-healthy eating looks like:

  • Quality proteins from meat, fish, eggs, and poultry
  • Healthy omega-3 fats from fish and seafood, as well as those from avocados, nuts & seeds, olives and olive oil
  • Vegetables, and some fruits, that are high in antioxidants and fiber

Other things that make for a heart-healthy routine include:

  • Moving your body (exercise, walking, an active job)
  • Consistent and adequate sleep
  • Effective stress management
  • Improving your mood and mental health

Most heart-healthy interventions begin with empowering each patient to take back control of their health. You have more power than you think to dramatically change your health and quality of life.

Keep reading: How to Reduce Your Risk of Heart Disease with Integrative Medicine

Work with your integrative doctor to determine the risks and benefits of statin therapy

Screening for cholesterol levels is an important part of being proactive with your health and longevity, but the best treatment for lowering cholesterol if you have lipid dysregulation isn’t always a medication.

Your integrative doctor is qualified to discuss risks, effective methods for cholesterol management, and to create a personalized plan that includes dietary and lifestyle modifications as well as complementary therapies. A functional approach ensures you’ll have an entire collaborative team for treating high cholesterol in the most effective, individualized way possible.

Resources

  1. https://www.nature.com/articles/s41598-020-65100-2
  2. https://pubmed.ncbi.nlm.nih.gov/17110240
  3. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.045713
  4. https://pubmed.ncbi.nlm.nih.gov/19622820/
  5. https://www.frontiersin.org/articles/10.3389/fcvm.2021.637366/full
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109527/
  7. https://pubmed.ncbi.nlm.nih.gov/32696080/
  8. https://www.mdpi.com/1422-0067/22/15/8074
  9. https://medlineplus.gov/ency/article/000392.htm
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988224/
  11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988224/figure/fig5/
  12. https://pubmed.ncbi.nlm.nih.gov/22732744/
  13. https://www.sciencedirect.com/science/article/pii/S0735109711049898?via%3Dihub
  14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126440/
  15. https://linkinghub.elsevier.com/retrieve/pii/S0140673604170189

Tags

Cholesterol, Heart, heart health, heart health month, high cholesterol, holistic heart health, integrative approach to high cholesterol


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