In the three decades since cholesterol-lowering statin drugs hit the market, they’ve been hailed as a medical breakthrough for cardiovascular disease (CVD), now the nation’s number-one killer, responsible for the deaths of one in four Americans. They’ve also become the biggest selling class of pharmaceuticals of all time: More than 24 million Americans are now estimated to take statins.
“It’s well-established that statins can lower the risk of [CVD],” says Robert Rountree, MD, holistic physician and Delicious Living’s medical editor. But new research, he says, “indicates the primary mechanism by which statins lower risk is not by reducing LDL cholesterol but instead by decreasing systemic inflammation.”
And if that’s the case, there are plenty of diet, lifestyle, and supplement strategies that can accomplish the same thing—without potential side effects ranging from muscle pain to liver damage. If you are already taking statins, making healthy changes may allow you to reduce or even eliminate statin use over time, with guidance from a health care professional. Here’s what you need to know to make an informed decision.
Statins lower cholesterol by inhibiting HMG CoA reductase, an enzyme that helps the body make cholesterol, explains Mark Houston, MD, director of the Hypertension Institute of Nashville and author of What Your Doctor May Not Tell You About Heart Disease (Grand Central, 2012). “This reduces total cholesterol, LDL cholesterol, and triglycerides,” he says. That’s helpful because, in the bloodstream, LDL (low-density lipoprotein, or “bad” cholesterol) and triglycerides increase inflammation, oxidative stress, and immune dysfunction that cause plaque buildup on artery walls, restricting blood flow and leading to heart disease and possible heart attack.
But simply lowering bad cholesterol doesn’t address the underlying problem, says Houston. That’s partly because plaque tends to develop where artery-wall lining has already been damaged—by high blood pressure, diabetes, chronic inflammation, or an autoimmune disorder. Scientists don’t yet fully understand why these conditions cause arterial deterioration, but they do know lowering bad cholesterol is only one piece of the puzzle.
Indeed, mounting research shows raising HDL (high-density lipoprotein, or “good” cholesterol) may be equally important for reducing CVD risk. HDL mops up excess cholesterol in the blood and takes it to the liver for breakdown. So the higher the HDL level (60–80 mg/dL is optimal), the less “bad” cholesterol in the blood. In a new study in The American Journal of Cardiology, increased HDL levels translated to lower CVD risk among diabetics.
Adopting a holistic plan to improve heart health—one that includes smart diet and lifestyle strategies—is most likely to lead to long-term wellness. “You cannot take your statin, and then go eat at McDonald’s and expect it to work,” says Mark Hyman, MD, founder of The UltraWellness Center in Lenox, Massachusetts.
Even lowering your LDL level to the optimal range (less than 100 mg/dL) isn’t a magic bullet, he says. In a 2009 study of nearly a quarter million people hospitalized with coronary artery disease, almost half had optimal LDL levels. That’s because LDL particles vary in size, says Houston. Small, dense LDL tends to clog arteries; large, fluffy particles can float right through. Unless your LDL is very low (less than 60 mg/dL), he adds, statins aren’t especially good at targeting problematic small particles—which means that although the drugs may have lowered your LDL, you might still be at risk.
Moreover, research shows statins tend to work best for people who already have a history of heart disease and heart attacks. A 2010 research review found that statins did not prevent mortality among those who were just at risk of developing heart disease because of family history, high cholesterol, and other factors.
And although statins are considered safe drugs, their use can have downsides. Potential adverse effects include muscle weakness and breakdown, liver dysfunction, and possible links to memory loss and nerve damage, says Houston.
A new study helmed by David Jenkins, MD, PhD, DSc, the University of Toronto nutrition professor who created the glycemic index concept, tracked patients who followed this diet, which combines proven cholesterol-lowering foods: soy proteins such as tofu and soy milk; sticky soluble fiber from oats and barley; plant sterol ester–enriched margarine; and tree nuts such as almonds and walnuts. Over six months, participants’ LDL levels dropped about 13 percent, results comparable to statins and far better than eating a traditional low-fat diet. In addition, Houston recommends the research-backed Mediterranean diet, which emphasizes high-quality lean protein and healthy fats like fish and extra-virgin olive oil, along with lots of fiber-rich produce (six vegetable and four fruit servings daily).
Cardiovascular exercise strengthens your heart, raises good cholesterol, and lowers bad cholesterol. Start by walking, jogging, swimming, or cycling 20 minutes, along with 40 minutes of resistance training daily, and gradually work up to longer sessions four days a week, says Houston. Your goal: lose visceral abdominal fat, a major risk factor. (While you’re at it, if you smoke, quit. It raises bad cholesterol and lowers good, and is the most preventable CVD risk factor.)
Avoid trans fats, which lower HDL and raise LDL. They’re most often found in processed foods and baked goods—and don’t trust “No Trans Fats” label claims. A loophole allows 0.5 grams of trans fat per serving to go unlabeled, so if you eat more than one serving or more than one kind of packaged food, you’re getting a serious amount. Too many saturated fats, found in animal products such as red meat and butter, also can negatively affect cholesterol levels, so reduce intake.
Research shows EPA and DHA, the omega-3 fatty acids found in cold-water fish such as salmon, mackerel, and sardines, reduce triglycerides. They also lower inflammation; scientists believe they counteract the effects of inflammatory substances and cells in the body, such as prostaglandins and macrophages. If you don’t eat much fish, take fish oil. Flaxseed and its oil also battle inflammation, thanks to ALA, another fatty acid. (See “Choosing the Best Omega-3 Supplement.")
In a review of more than 200 studies, researchers linked eating high glycemic index foods such as white potatoes, sugar, white rice, and white bread with increased CVD risk. Along with sugary sodas, these foods cause inflammation and trigger harmful small LDL. Choose fiber-rich whole grains and produce such as raspberries and pears. Savor dark chocolate. Antioxidant flavonoids in cocoa can reduce oxidation of bad cholesterol, and high-polyphenol dark chocolate boosts good cholesterol levels, according to recent studies. Be sure to relish just a square or two; most chocolate also contains saturated fat.
Recent studies link drinking purple grape juice and very moderate amounts of red wine (up to two 4-ounce servings daily for men and one 4-ounce serving daily for women) to improved heart health and reduced inflammation, due partly to the powerful antioxidant resveratrol. Ditto for anti-inflammatory green and black tea: Drinking three cups a day or more translates to better cholesterol ratios and lower heart attack risk. Finally, growing research indicates that antioxidant curcumin, derived from the curry spice turmeric, prevents disease and fights inflammation. To get enough, consider high-quality supplements of both resveratrol and curcumin.
Even with all these diet and exercise measures, some people still need statins for heart health. To assess whether that’s true for you, develop a step-by-step lifestyle-change plan with your physician, while slowly decreasing statin use. Eventually, if you stick with it, you may find yourself enjoying a true heart-healthy—and statin-free—lifestyle.