When I tell high-risk patients that I think they should take a statin drug
and explain why it will help to improve their cholesterol levels, they
usually agree. But it is not unusual to get some resistance from
patients who aren't well informed about the potential benefits or side
effects of these drugs.
The following are some typical patient reactions:
"No! I don't want to take any medications. I want to lower my
cholesterol naturally, without drugs and their side effects. Won't drugs
fry my liver?"
"Sign me up! I'd rather take a pill than worry about my diet or bother with exercise!"
In both cases, these patients are just cheating themselves.
Patients who reject medications because they think they're not
"natural" are missing out on some of the best tools in aggressive
prevention. Statin drugs alone can slash the risk of having a heart
attack by more than 30 percent — and by much more than that when taken
in combination with other drugs such as niacin, aspirin, and/or certain blood pressure medications.
I am quick to remind patients who make remarks about drugs not
being "natural" that there is nothing "natural" about having a sick
artery that is burdened with plaque. I also tell them that statin drugs
can actually help to restore the artery to its youthful, flexible state —
the way that nature intended it to be. And I remind them that a truly
"natural" cholesterol level is in the low 100s. At least that is the
level found in populations with unprocessed, non-Western diets.
Patients who think that popping a pill renders diet and exercise
unnecessary are also making a deadly mistake. Drugs are meant to work
together with these lifestyle changes; they are not meant to replace
them. Even if a combination of drugs can reduce your risk of having a
heart attack by 50 percent, half of all people taking these drugs who
were destined for a heart attack will still have one. That's why making lifestyle changes is so essential to further reduce risk.
Although I am a passionate believer in the power of diet and
exercise, given what we know today about the effectiveness of statins
and other drugs, it makes no sense at all for at-risk patients not to
take them. I made this point recently when I was lecturing at a major
medical center about the benefits of good fats, good carbs, and lean
protein to a group of physicians. At the end of my talk, after having
built a strong case for the role of diet in heart disease prevention,
one doctor asked if I would be willing to conduct a study that tested
the principles of the South Beach Diet as a sole therapy for patients
with coronary artery disease. I was adamant that I would not. Using diet
alone to treat heart disease would be ignoring 30 years of lifesaving medical advances.
So does that mean that statins should be universally prescribed in a
manner akin to adding fluoride to drinking water to reduce tooth decay?
That would be going too far. But statins have generally been
underprescribed.
Despite numerous excellent studies documenting their effectiveness,
millions of people who should be taking these cholesterol-lowering
drugs are not. This means that millions of Americans have an
unnecessarily high risk of suffering a heart attack, stroke, or sudden
death.
A Word of Caution:
Tell your doctor about all the medications and dietary supplements
you take regularly, whether they're prescription or over-the-counter.
When taken in combination with other drugs, many otherwise safe
medications can interact, causing potentially dangerous side effects.
Never stop taking a heart medication without consulting your doctor.
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