Steven Nissen, MD, controversies in cardiology, control your cholesterol

What causes heart disease? There are a number of risk factors, including cigarette smoking, sedentary lifestyle, high blood pressure, diabetes and others. One well-known risk is high cholesterol. Has your doctor told you that you need to control your cholesterol?

New Guidelines for Cholesterol Control:

The principal cardiologists’ organizations in the US recently updated their guidelines on treating high cholesterol. The American Heart Association and the American College of Cardiology made changes to the recommendations they had issued in 2013. Will the new treatment suggestions change the way you control your cholesterol?

Dr. Steve Nissen of the Cleveland Clinic describes how the guidelines have changed. We discuss who should be taking a statin drug to lower cholesterol and how you would know if your heart attack risk is high enough to warrant medication. Dr. Nissen recommends the Reynolds Risk Calculator. To fill it out, you’ll need to know some information you can get only from blood tests: total cholesterol, HDL cholesterol and high-sensitivity C-reactive protein, a measure of inflammation. The decision of whether or not a medication is needed should be a joint decision by both the patient and the healthcare provider.

In addition, Dr. Nissen tells us why he doesn’t routinely send his patients for calcium coronary scans. You can read about his study on the effects of statin drugs on coronary calcification here.

Join the Conversation:

We invite you to tell us how you control your cholesterol. Do you take a statin drug? Has that worked well for you? We will consider both benefits and possible side effects. Have you found other ways to control your cholesterol? When a statin is not enough, what are your options? Are you taking one of the new PCSK9 inhibitor medications, Repatha or Praluent? You may call 888-472-3366 between 7 and 8 am EST on Saturday, January 5, 2019. Or send us email: radio@peoplespharmacy.com

Dr. Robert DuBroff’s commentary, A Reappraisal of the Lipid Hypothesis, was published in the American Journal of Medicine, September 2018.

This Week’s Guest:

Steven Nissen, MD, is chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at the Cleveland Clinic. He is the co-author, with Marc Gillinov, MD, of Heart 411: The Only Guide to Heart Health You’ll Ever Need.

Listen to the Podcast:

The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free. CDs may be purchased at any time after broadcast for $9.99.

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Air Date:January 5, 2019

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  1. Vee
    NC
    Reply

    Tricor caused my liver enzymes to go from a normal level of 40 to over 500! I was in liver failure and had to be admitted to the hospital for 3 days!!! I can’t take regular cholesterol-lowering meds due to muscle weakness. I just can’t take anything. So I’ve stopped eating cheese, and eat more fruits/veggies.

  2. Helen
    Mississippi
    Reply

    Thank you for the People’s Pharmacy. I have gained so much helpful information from your podcast and the articles, especially the ones on hypertension, statins, and blood pressure medications.

  3. Marilyn
    Georgia
    Reply

    I was prescribed every cholesterol statin medication but couldn’t tolerate any of them, even in the smallest dose once every three days! I tried and over-the-counter cholesterol medication, as recommended by my research. That caused my retina in my left eye to bleed. It has a steroid in it that gave me problems. So I take apple cider vinegar in the morning with water and try to eat better. My HDL Cholesterol is high, so of course my total will be high. But I think 246 total cholesterol is not that bad! My grandparents lived into their 80s without statin medications.

  4. J. David A.
    Springfield, MO
    Reply

    Vascular disease and heart attacks have multiple steps to develop and so have multiple points of intervention. Exercise, and statins and most of the other interventions have about the same range of benefits – some people will resolve plaque on 2 or 3 interventions – some need 8 or 10 including statins. I have several dozen patients who resolved their vascular disease including carotid lesions and aortic plaque by using multiple interventions. One patient resolved his plaque without a statin while another quit having “events” and stabilized his plaque despite pretty bad diabetes control.

    Some family docs have been using multiple risk reduction successfully for 25 years – unfortunately most have retired now. Perhaps a couple of shows with Dr. Low Dog on preventing and reversing and stabilizing plaque would take some of the confusion away. BTW, I used Zocor/simvistatin and Pravachol/pravistatin as they had less memory and myalgia side effects with easier to prove benefits on events and longevity but still 25% were intolerant and drug-drug interactions especially in older people were always a problem.

  5. J. David A.
    Springfield, MO
    Reply

    I had one patient and friend who ran 40-50 miles a week, no real family history of heart disease, smoked some in remote past, cholesterol 160, whose health-concerned wife fed him a minnow periodically – who presented with shortness of breath and chest tightness after running less than a mile and then slowly worsening. EKG and CXR were normal. I was familiar with all the cardiologists in the patient’s network from reviewing IPA data. My patient wanted the Chest CT calcium score to give an indication of whether his heart was the culprit – he was successfully revascularized a week later and eventually went back to jogging and had several plaque interventions which are well tolerated.

  6. mike
    ny,ny
    Reply

    Why are triglycerides rarely mentioned in all these lipid articles? many folks have high triglycerides but the meds like Tricor can cause the need for gallbladder removal in many (like me).

  7. Jane T.
    FL
    Reply

    I was looking forward to an article about lowering cholesterol and was disappointed. This had no suggestions.

  8. Pauline D
    Spokane, WA
    Reply

    Hi, I would like to tell you my experience with dealing with cholesterol. Sorry I didn’t get this message sent in while the program was still happening.

    I started looking at what I could do about my cholesterol levels about 30 years ago. My mother had had a heart attack when she was 62, survived it because she recognized what was happening and got help right away. I have other relatives, aunts and uncles on both sides of my family, who have died of heart attacks, and my brother had a quadruple bypass while in his 60’s. He and my other siblings have other heart-related issues like high blood pressure.

    I have had my cholesterol checked frequently over the years and kept records of results. My last list of records started in 1999. Then the overall cholesterol was 225, HDL was 61, and LDL was 149. This past June the numbers were overall 232, HDL was 65, and LDL was 140. Blood Pressure that day was 102/64. In between these two times the lowest overall number was 219, the highest was 239. Otherwise the HDL and LDL also didn’t vary much. And my blood pressure has remained low.

    I have not taken any statin drugs. I believe that the reason that my cholesterol levels stayed where they did is because of the diet and exercise I got. I stayed away from red meat, fried food, eggs and dairy products especially cheeses and the fattier dairy products like ice cream. On the other hand, I eat salmon frequently. I avoided egg yolks until very recently when I heard that they were likely not bad for us. I used to try to get my cholesterol checked frequently, but my current (last 7 years) doc doesn’t think I need to be that concerned about it.

    Now I’m attempting to live on a vegan diet for the sake of the planet. I think my cholesterol should get lower on this account, but that is not my reason for following this diet.

    Early on I resisted statins because of the side effects I had heard about. Now, at 79 years old, I am glad I did. I’m a relatively active 79 year old. Don’t have diabetes or arthritis, I still drive and am involved in volunteer work for the planet.

    I enjoy your radio show and try to listen every Sunday on Public Radio in Spokane, WA (KSFC).

  9. Jan
    NC
    Reply

    The doctor I was seeing in the late 90’s started me on statins. Soon after that I started having leg cramps, and my memory was affected. Went back to the doctor, and he put me on a different statin, This went on for sometime. I think he tried every new statin that came on the market with the same results. I learned about Red Yeast Rice from a friend. Talked with the doctor about trying that. No problems with it, so have been taking it for 20+ years. However, I still have some of complications from all the statins I tried.

  10. Pamela
    MO
    Reply

    I am so confused about all the heart health information. When I stopped my statin and used Red Yeast Rice my cholesterol skyrocketed over 100 points in less than a month. My calcium score is over 1200 but, with a stress test, my doctor says my heart is OK. I certainly don’t feel like anything is wrong with my heart, I can do treadmills and exercise with no problems. However, now I have to wrap my head around the fact I am a “heart patient”. My heart doctor says, since I am a diabetic, I can’t help but have a high calcium score, but I have a diabetic friend in my 70’s age group, whose calcium score is under 35, go figure.

  11. Jim
    Missouri
    Reply

    Like Tony I take a statin to “placate” my Dr.

    My Reynolds Risk Score came in at a reassuring 13%
    Gender: Male Age 70
    Do you currently smoke? No
    Systolic Blood Pressure (SBP) 124 mm/Hg
    Total Cholesterol 266 mg/DL
    HDL or “Good” Cholesterol 47 mg/DL
    High Sensitivity C-Reactive Protein (hsCRP) .13 mg/L
    Did your Mother or Father have a heart attack before age 60 ? No

    I had to retire at 63 due to memory-related effects of Pravastatin.
    At 68 I ‘finally’ convinced my Dr. of the problem – he changed me to Resuvastin.
    I’m on that today.

    My chiropractor son said “get off those killer statins”
    My pharmacist daughter said “do what the Dr. says”

    Who am I to trust?

    • Tony
      Fl.
      Reply

      Greetings Jim from MO.
      Besides the Reynolds Risk Score, I took the Heart Risk Calculator test here;
      http://www.cvriskcalculator.com
      After putting in what I consider ‘optimally perfect’ numbers, for some one my age [81],
      it still said I had a 32% chance of a heart attack or stroke in the next 10 years, and recommended that I take a statin drug..
      SOOO!!!
      The question becomes, can I reduce my chances of a heart attack or stroke by taking a
      statin drug when my numbers are already ‘OPTIMALLY PERFECT” ????????

    • Marie - Sweden
      Reply

      Read books, articles etc – and try to make up your own mind!

      I am not in health care – just an ordinary person five years older than you.
      I have never taken statins – nor will I. I saw what happend to my mother – cramps, aches and pains in her legs, muscle weakness and sleeping problems. She had been on Zocor (=simvastatin) for a year or so.

      By chance, I came across a cholesterol sceptic book by a Danish/Swedish scientist/doctor. Uffe Ravnskov. I also found the network that he founded together with some others – http://www.thincs.org.
      I looked for patient stories on the Internet.

      To make a long story short – my mother stopped the medication little by little and was lucky to recover (some don`t). She was without statins for around 15 years, when I discovered, to my horror, that she – once again – had been prescribed a statin at the age of 97. This time it was atorvastatin (=Lipitor).
      I asked what had happened and she told me that the doctor had said that she had to take it! This is what happens now and then – medical staff scare people into obedience.

      Over the years I have read many critical and interesting books. They have opened my eyes and I hope they will open yours. Here are some suggestions:

      Statins Toxic Side Effects (David Evans)

      Doctoring Data (Malcolm Kendrick)
      Statin Nation (a new book by Malcolm Kendrick)

      Too many pills (James Le Fanu writes about the most common medications for middle aged and old people – the pros and cons of bloodpressure pills, statins, etc. and the book is full of statin stories.

      You will find more stories if you visit http://www.askapatient.com (search for Crestor = rosuvastatin and the other statins). It has been known for years that statins can affect memory and mood. As a matter of fact the first book that I read on this subject had the title – Lipitor – thief of memory – and was written by another cholesterol sceptic – Duane Graveline. The first edition of this book was published in 2004!
      Dr. Graveline passed away on September 5th, 2016 at the age of 85. He did everything in his power to make people aware of the risks (Peoples Pharmacy published his statin story when others refused). His web site is still running, http://www.spacedoc.net. There are lots of stories in the “Forum”.

      P.S.
      My mother had a small heart attack when she was around 80 and that´s when she was prescribed a statin for the first time.

  12. Don
    south florida
    Reply

    Being a Type 1 diabetic my Endo was insistent to keep my cholesterol at 175 or lower for heart problems. I have been taking a statin for around 15 years.

    • Tracy
      Benicia, Cal
      Reply

      Listen to your son. I took statins for two weeks (14 pills). I now need a cane to walk. The statins attacked my leg muscle tissue. My legs are so weak I can’t get up from the floor without assistance. I used to snow ski, bike ride, etc. Any physical activity leaves me in pain for days. Statins have ruined my life.

  13. Pat
    Virginia
    Reply

    statins caused major leg cramping so poor sleeping…tried about every kind…gave up until I started using Tribiotics that I learned about during a gut cleanse…drop #’s over 80 points, triglycerides 100 pts still not as low as they would like but have not gotten recent tests back yet

    • JC
      NC
      Reply

      Hi Pat, I’ve had the same problem with taking statins and wanted to ask you if you would share the brand of tribiotic and amount you used that helped you. Thanks

      • Pat
        Virginia
        Reply

        Nutricology, TriBiotics
        took 2 a day in the beginning, and since it is down, take 1 a day.

  14. Florence
    NV
    Reply

    Reduced my hubby’s cholesterol over 150 points to a normal level by eliminating all unnatural oils. That means all the veggie oils. We use olive oil, coconut oil, avocado oil to make mayonnaise, bacon drippings for cooking etc. Lard or butter instead of shortening for baking.

  15. jay bunzey
    lake norman
    Reply

    I have been using pravastatin for 25 years with no ill effects as of yet,

    • Randa
      Oregon
      Reply

      Diet cannot be overlooked! I lowered my cholesterol by 50 points after just 5 months of eating a paleo diet. My doctor had recommended statins but was thrilled with these results.

  16. John
    Oregon
    Reply

    Cholesterol is not the problem. The problem is tissues that become inflexible and tear. Plaque is the scab of the blood stream. Concentrate on collagen production for the whole body. Supplementation with amino acids and mineral/vitamin is all you need to regain flexible tissues in the cardiovascular system and everywhere else. A little research and you can figure out what is required. Also stay away from factory meat and processed foods, go organic or local where possible.

  17. BAB
    TX
    Reply

    I subscribe to ConsumerLab.com and followed their recommendation for the best red yeast rice. I take Cholestene Red Yeast Rice two 600mg capsules twice a day. I lowered my LDL nearly 100 points from 174 to 87 with no side effects in less than a year.

  18. Tony
    Fl.
    Reply

    To ‘placate’ my Doctor, I take Weiders Red Yeast Rice, with Phytosterols…
    I’m not sure what to believe any more about what Doctors say about Cholesterol…
    I have read that more than 50% of the people who have heart attacks, DON”T have a cholesterol problem…And Doctors just DON’T like to talk about that aspect…
    Many Doctors claim it is the Omega 6 oils that cause all the problems…
    A former Internist of mine, recommended the Red Yeast Rice to me instead of the Statins…
    He was amazed, when it dropped my total Cholesterol from 239, down to 171…
    In addition, I take “Fish Oil” capsules to get more Omega 3’s into my system, and balance out
    the Omega 6’s I consume…

  19. Milton
    Richardson, Texas
    Reply

    I have been taking Cholestoff and Red Yeast Rice now for around 10 years with fantastic results. The statins my doctor put me on years ago played havoc with my memory and the ability to find the words I wanted to say.

    • Bob
      Greer, SC
      Reply

      I also was taking statin meds with accompanying muscle pain. On the advice of my brother, I followed his lead by taking plant sterols and stanols via Cholestoff. I was somewhat surprised the program did not include this more natural approach to addressing high cholesterol in the discussion. I did attempt to call into the program, but was too late to have my call accepted. Regardless, my cholesterol levels are now at an acceptable level without the need for statins.

  20. Janice
    Durham, NC
    Reply

    I am not able to take statin drugs. My cholesterol went from 280 to 250 by not eating much meat during the last 6 months. I no longer eat pork and eat meat about once a week, including foods like spaghetti that have meat. I eat turkey, turkey sausage, kielbasi, and bacon, as well as chicken and fish.

    • C.J.
      Nc
      Reply

      I have heard that Red yeast rice is the same as a stating only unregulated. How to know a good one. What is in Cholestoff?

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