Doing what you can to prevent heart attacks, strokes, and death is an important endeavour in your pursuit of a healthy lifestyle. And often, lowering your cholesterol is part of that conversation with your doctor or medical practitioner. However, the first step to take when assessing the importance of lowering your cholesterol is to identify your primary goal. For instance, is the goal to achieve better lab numbers? Or is it to reduce the risk of heart attack, stroke, and death?
The answer should be fairly obvious. Unfortunately, patients and doctors alike can frequently lose sight of the ultimate goal and get caught up in the numbers.
It is a common misconception that to lower your risk of heart disease, you must lower your cholesterol. According to recent studies, that may not be the case. For example, the PREDIMED study demonstrated that those following a Mediterranean-style diet, full of fruits, vegetables, nuts, olive oil, and fish had a decreased risk of cardiovascular disease compared to the control group following a lower-fat control diet. What’s even more impressive is that the risk of cardiovascular disease was reduced even though the LDL cholesterol (often referred to as the “bad” cholesterol) didn’t decrease.
In addition, a recent study in NEJM found that in individuals at the highest genetic risk for heart disease, healthy lifestyle habits can cut the risk of heart attacks in half. Once again, the study showed no meaningful reduction in LDL cholesterol.
Clearly, there is more to being healthy and reducing the risk of cardiovascular disease than simply lowering LDL cholesterol.
Statin Drugs vs. Lifestyle Changes
A common prescription for lowering LDL cholesterol is the use of statin drugs, which reduce the production of cholesterol by the liver. Statin trials, such as the Jupiter study, demonstrated that statins can help lower risk of cardiovascular disease not just by lowering the LDL cholesterol, but also by lowering the body’s inflammation. In this trial, only those who had a reduction in the hsCRP (a measurement of inflammation) benefitted from the statin drug. Those who lowered their LDL cholesterol, but not their hsCRP, did not benefit nearly as much.
If the goal then is to reduce your body’s inflammation to reduce the risk of heart attacks and death, a lifestyle change is paramount for treatment. Eating healthy, fresh foods can have an anti-inflammatory effect on your body.
Unfortunately, there has never been a randomized trial comparing comprehensive lifestyle intervention to statins and the subsequent risk of heart attacks and death. However, since lifestyle changes can be effective (as evidenced by the studies referenced above), and they come without the adverse side effects of some medications, purposeful lifestyle interventions should be the initial therapy of choice for primary reduction of cardiovascular risk.
Making Lifestyle Changes
To help reduce your risk of heart attack, stroke, and death, your first-line therapy should include:
- Improving nutrition to focus on a vegetable-based, real food, Mediterranean-style eating with healthy fats
- Daily physical activities
- Practicing stress management and good sleep habits
If your doctor recommends lowering your cholesterol with a statin, start asking questions—and lots of them. Here are some to start the conversation:
- How high is my calculated cardiovascular risk?
- How much will a statin reduce that risk?
- What else can be done to better define my risk (i.e., coronary calcium score)?
- What else can be done to lower my risk (i.e., intensive lifestyle modifications)?
By answering these questions, you can make a more informed decision about whether a statin or other drug is needed to significantly lower the risk of heart attack, stroke, and death.
However you choose to move forward, it’s your decision to make after hearing professional opinions, taking into account your own goals and fears. Unfortunately, current guidelines under appreciate the beneficial effects of purposeful lifestyle interventions.
The ultimate goal is improving your health, reducing the risk of chronic disease and death, and improving your quality of life. Nutrition, exercise, and stress management are an ideal place to start.