Statins, Atherosclerosis and Heart Failure
By Renata Trister DO
Statins are the world’s most-prescribed group of medications. Roughly one in four Americans age of 45 and over take these medications (such as Pravachol, Lipitor, Zocor etc.). These drugs for primary used for prevention of heart attacks and strokes.
However, mounting research suggests that there may be a previously unrecognized risk to these medications. Although controversial, this view should be explored.
In contrast to the current belief that cholesterol reduction with statins decreases atherosclerosis, recent studies have concluded that progression of coronary artery calcification, which a key feature of lethal heart disease, is actually increased with statin use. This research showed that statins may be causative in coronary artery calcification and can function as mitochondrial toxins that impair muscle function in the heart and blood vessels. This is accomplished through the depletion of coenzyme Q10 and ‘heme A’, and subsequent ATP generation. Statins inhibit the synthesis of vitamin K2, the cofactor for matrix Gla-protein activation, which in turn protects arteries from calcification. Statins also inhibit the biosynthesis of selenium containing proteins, one of which is glutathione peroxidase serving to suppress peroxidative stress. An impairment of seleno-protein biosynthesis may be a factor in congestive heart failure, similar to the dilated cardiomyopathies seen with selenium deficiency. The epidemic rates of heart failure and atherosclerosis seen in this country may actually be aggravated by the pervasive use of statin drugs. Perhaps the current statin treatment guidelines need to be reevaluated.
Statin drugs work by preventing the formation of cholesterol and reduce LDL cholesterol. LDL is what is considered the “bad” cholesterol. Statin drugs can effectively lower your cholesterol levels. This is certain. However, what has not been shown is weather statins lower the risk of dying from heart disease. Statins do not treat the underlying cause of the problem. They are actually more of a band-aid.
In order to understand this process, first one needs to understand the biological action of cholesterol. There is really no such thing as “good” or “bad” cholesterol. Both HDL and LDL cholesterol perform vital functions in your body.
HDL (high density lipoprotein) and LDL (low density lipoprotein) are transport proteins that carry the cholesterol to and from your tissues. Cholesterol in turn is a precursor to steroid hormones, bile acids, cell membrane walls and vitamin D. For example, cholesterol is an essential building block of testosterone/ estrogen, cortisol, DHEA and a multitude of other steroid hormones that are necessary for health. Furthermore, all cell membranes are made with cholesterol and cells cannot regenerate their membranes without it.
LDL is there to transport cholesterol to the tissues in order to make new cells and repair damaged ones. However, there are different sizes of LDL particles and it’s the LDL particle size that is relevant. Statins do not affect the size of the LDL particles. The LDL particles are sticky, and the very small LDL particles can get stuck in different areas, build-up and eventually causes inflammation and damage.
The only way to make sure your LDL particles are larger so to not cause damage is through diet. In fact, it is one of the major functions of insulin.
A healthy diet is also the answer for type 2 diabetes, so by focusing on diet, both diabetes and high cholesterol levels can be managed, thereby reducing the associated risk of heart disease. Proper diet currently is the only known good way to regulate LDL particle size. LDL particles that are the right size function properly – bringing the cholesterol tissues, the HDL takes cholesterol back to your liver, and no plaques are formed.
As statins work to lower risk of heart disease, but their benefit is probably independent of their designed pharmacological function. It is likely that the benefits of statin drugs come from anti-inflammatory action. Since cholesterol is your body’s response to inflammation/cell damage/need for repair, decreasing inflammation will decrease the need to produce cholesterol. The effect of statins on cholesterol could at best be just a side benefit, at worst a cause of multiple systemic problems.
Side effects of statins
Statins interfere with the manufacture of cholesterol. But cholesterol is an important ingredient in cell membranes and nerve sheaths; it is also a substrate from which other essential hormones and molecules are made including vitamin D. As such, statins carry powerful complications. Most of the side effects come from the cholesterol metabolism, and not the anti-inflammatory action.
Lowering inflammation usually improves insulin sensitivity. But most statins are associated with elevated risk of diabetes. Since loss of insulin sensitivity is integral to aging, any effect on insulin resistance could be important. Diabetes is an independent risk factor for heart disease. Simvastatin seems to have the worst effect on insulin sensitivity.
Muscle cramping (myalgia) is reported in some studies to be 18% or 5% or even as low as 3%. This can become clinical risk when it interferes with patients’ ability to exercise, which is potentially a more powerful heart protector than statins. People on statin drugs report fatigue and intolerance to exercise. Statins interfere with the energy metabolism, and in particular reduce the concentration of CoQ10=ubiquinone, which already declines with age and is essential for mitochondrial function. Often for patients who take statins, a CoQ10 supplement is recommended.
Alternatives for lowering cardiovascular risk without statins
Exercise. The #1 most cardio-protective form of exercise is interval training. However the discipline to maintain interval training is very difficult. Establish an exercise program you can live with, and incorporate it into your daily routine. Intense exercise has a tremendous effect, but even taking a walk a few times a week can have a significant benefit.
Weight loss, heart health, anti-inflammation, and anti-cancer.
Daily low dose aspirin after age 50 is useful for some. Other anti-inflammatories include turmeric, fish oil, boswellia, and cat’s claw.
Coenzyme Q10 (CoQ10) is a natural antioxidant synthesized by the body, found in many foods, and available as a supplement. It comes in two forms: ubiquinol, the active antioxidant form, and ubiquinone, the oxidized form, which the body partially converts to ubiquinol. Coenzyme Q10 is beneficial for heart health in many ways. It assists in maintaining the normal oxidative state of LDL cholesterol, benefits circulation, and supports the heart muscles. Statins reduce the natural levels of CoQ10 in the body.
10 cardio protective foods
• Olive oil
• Tea (black is good, green is better)
Trans fats (or partially hydrogenated vegetable oils) do not exist in nature, but are created in food processing because they retard spoilage. Trans fat consumption is associated with heart risk as well as all-cause mortality, and should be avoided.
Cut sugar and grains to keep up your insulin sensitivity. Diabetes is a heart risk factor.
Despite high rates of smoking (men 62%), Chinese has a low rate of heart disease (less than a third of the US). The rate in cities has begun to climb to rates more typical of Western societies, but remains low in the countryside Part of the reason may be the Chinese diet and traditional Chinese medicine. Astragalus and ginseng are considered to be cardio-protective. Auricularia or wood ear mushroom is used in traditional Chinese medicine. It tends to raise HDL and prevent inflammatory damage to blood lipids, and it mitigates damage in the event of a heart attack. Oyster mushrooms are a natural source of simvastatin. Red yeast rice or red koji contains a statin like molecule, but its use, manufacture and sale in the US has been controversial.