Are Statins Enough? How to Help Protect Your Heart

Are Statins Enough? How to Help Protect Your Heart

We all want to prevent heart attack and stroke so that we can maximize time spent with our family and friends as well as in leisure and work for years to come. But for many of us, healthy eating and regular exercise aren't enough to control LDL-cholesterol and high triglycerides, and both of these lipids can lead to blocked arteries that cause heart attack and stroke.[1] Millions of American adults need and receive statin therapy, which is proven to lower cholesterol that can help reduce hardening of the arteries.[2]

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Despite the benefits of good control of cholesterol levels with statins (and other, newer, cholesterol-lowering treatments)2 many heart attacks and strokes still occur, which remain the number one and number five causes of death in the U.S.3 While cholesterol management to lower heart risk is usually adequate with statin therapy, unfortunately, controlling cholesterol alone is often not enough for at-risk patients.4

"Statins are proven to reduce roughly one-third of heart attacks and strokes," says Eliot A. Brinton, M.D., FAHA, FNLA, FACE and president of the Utah Lipid Center. "But even when cholesterol is well-controlled, heart attack and stroke risk can still remain high. After working with our healthcare providers to lower our cholesterol to the right levels, we also need to remember other factors in residual cardiovascular risk such as triglyceride levels. We need to have our triglycerides tested and then work with our physicians on additional treatment options, if needed."

This is especially the case for patients who have already had a heart attack. For these people, the chances of having another cardiovascular event remains high.5 Adults with diabetes are also at increased risk—they are two-to-four times more likely to die from heart disease than adults without diabetes.6 The American Heart Association considers diabetes to be one of the seven major controllable risk factors for cardiovascular disease.7

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Dietary Supplements on Top of a Statin are Not the Answer

Many people may try to lower cardiovascular risk that remains during statin therapy by adding dietary supplements to their diet. For example, omega-3 dietary supplements have a reputation for improving heart health, however, they are not intended to treat diseases. Unfortunately, several studies have shown at best only a "low-certainty" association of omega-3 supplements with reduced cardiovascular risk.8 In August 2019, the American Heart Association (AHA) pointed out that dietary supplements are not intended to treat diseases and told healthcare providers that they should not recommend omega-3 dietary supplements to their patients with high triglyceride levels.9 Unfortunately, omega-3 supplements are not FDA approved and consequently are not subjected to the same level of testing and regulation as prescription medications.10 So, if triglyceride levels need to be lowered further after a patient is taking a statin, omega-3 dietary supplements are not appropriate.9

"Dietary supplements are not medicines," says Peter Toth, M.D., Ph.D., FCCP, FAHA, FESC, FACC, director of Preventive Cardiology at CGH Medical Center in Sterling, IL, and Professor of Clinical Family and Community Medicine at the University of Illinois College of Medicine in Peoria. "Certainly, supplements—which include essential vitamins and minerals—may play a role in managing good health, but in terms of reducing the risk for serious complications related to heart disease, there is no supplement that is proven safe and effective to treat patients with cardiovascular disease."

Expert Advice on Maintaining a Healthy Heart

Drs. Brinton and Toth offer the following advice for maintaining a healthy heart:

  • Eat heart-healthy: Eat mainly whole grains, vegetables, fruits, legumes fat-free or low-fat dairy products and fish. One can add to this moderate amounts of nuts, seeds and vegetable oils (except coconut and palm oils), and modest amounts of lean meats, skinless poultry and eggs. This diet will help keep intake of sodium, saturated fat and added sugars to safe levels.
  • Work towards a healthy weight: Regular exercise is good for many reasons, including maintaining appropriate weight. Ask your doctor how to increase your physical activity safely. A healthy body mass index (BMI) for adults ranges between about 18 and 25. You can search online for a BMI calculator.
  • Start and maintain new habits: Manage your stress and quit smoking to reduce your risk for cardiovascular disease and its serious complications.
  • Ask your physician about your best treatment options: Don't rely on the advice of your neighbor or friends who are not trained heath care professionals and who may be inclined to rely on misinformation from the internet, rather than proven medical results in FDA-reviewed studies. Your health is very important and difficult to maintain without knowing the facts.
  • Don't make assumptions about your heart health: Get your lipids tested and be evaluated for high blood pressure, high blood sugar and other risk factors for heart disease. These may need work in young-adulthood or even adolescence or childhood, and early intervention with diet and lifestyle can help prevent hardening of the arteries before it starts.

[1] "LDL Cholesterol & Heart Health." Cleveland Clinic, my.clevelandclinic.org/health/articles/16866-cholesterol-guidelines–heart-health.

[2] "Cholesterol Management Guide for Healthcare Practitioners." American Heart Association, https://www.heart.org/-/media/files/health-topics/cholesterol/chlstrmngmntgd_181110.pdf

[3] "Leading Causes of Death." Centers for Disease Control and Prevention, https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

[4] Ganda OP, Bhatt DL, Mason RP, Miller M, Boden WE. Unmet need for adjunctive dyslipidemia therapy in hypertriglyceridemia management. J Am Coll Cardiol 2018;72:330-43.

[5] "Stroke after a heart attack: What's the risk?" Harvard Health Publishing, https://www.health.harvard.edu/heart-health/stroke-after-a-heart-attack-whats-the-risk

[6] Deshpande, Anjali D et al. "Epidemiology of diabetes and diabetes-related complications." Physical therapy vol. 88,11 (2008): 1254-64. doi:10.2522/ptj.20080020

[7] "Cardiovascular Disease & Diabetes." American Heart Association, http://www.heart.org/HEARTORG/Conditions/More/Diabetes/WhyDiabetesMatters/%20Cardiovascular-Disease-Diabetes_UCM_313865_Article.jsp#.XWAS5ehKhhE

[8] Khan SU, Khan MU, Riaz H, et al. Effects of Nutritional Supplements and Dietary Interventions on Cardiovascular Outcomes: An Umbrella Review and Evidence Map. Ann Intern Med. [Epub ahead of print 9 July 2019]171:190–198. doi: 10.7326/M19-0341

[9] "Prescription omega-3 medications work for high triglycerides, advisory says." American Heart Association News, https://www.heart.org/en/news/2019/08/19/prescription-omega3-medications-work-for-high-triglycerides-advisory-says

[10] "Food Facts: Dietary supplements." U.S. Food and Drug Administration, https://www.fda.gov/media/79995/download

Sponsored Content: This article is developed and sponsored by the Amarin Group of Companies. Drs. Eliot A. Brinton and Peter Toth receive fees from Amarin for consulting services.

Are Statins Enough? How to Help Protect Your Heart, Source:https://www.rd.com/sponsored/are-statins-enough-how-to-help-protect-your-heart/

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