Cholesterol-Lowering Drugs for Everyone?

The American College of Cardiology/American Heart Association provides guidelines for the management of blood cholesterol. Their recommendation summary begins by stating that all people should follow a heart-healthy lifestyle during their life. From this point on, statin drugs as well as the newer PCSK inhibitors, are essentially recommended for everyone who has atherosclerosis, diabetes with LDL-Cholesterol (LDL-C) ≥70 mg/dL, those aged 40 to 75 years of age with a calculated 10year risk of atherosclerotic cardiovascular disease risk, and LDL-C ≥70 mg/dL, and those with severe primary hypercholesterolemia with an LDL-C ≥190 mg/dL.

Since the American College of Cardiology focuses on LDL-C as the primary focus for statin use, I researched statistics on how many Americans have an LDL-C ≥70 mg/dL. Disappointingly, the CDC states how many adults have a total cholesterol above 240 mg/dL (12%) and HDL-C below 40 mg/dL (17%) yet gives no statistic for LDL-C (CDC, 2022). In researching further, I could only find that 28.9% of American adults had LDL-C of 130 mg/dl or higher. Having reviewed thousands of lipid panels, I would estimate that a very low percent of the American population has a natural LDL-C below 100 and that LDL-C <70 mg/dL is rare. In essence, almost everyone is a candidate for cholesterol lowering drugs!

 

Interesting Research

The use of statins for the prevention and treatment of cardiovascular disease is quite mixed in the published literature in terms of preventing and treating cardiovascular disease. One of the factors has to do with how statistics are reported. For example, a 2022 systematic review and meta-analysis published in the mainstream JAMA Internal Medicine included 21 large, randomized clinical trials that examined the effectiveness of statins in relationship to cardiovascular disease and mortality. The results were less than impressive with an absolute risk reduction of 0.8% for all-cause mortality, 1.3% for myocardial infarction, and 0.4% for stroke.

 

Vital Functions

LDL-Cholesterol plays important physiological functions in the body and so aggressive suppression should be approached with caution. For example, LDL-C transports cholesterol and phospholipids required for the renewing of cell membranes. Healthy body tissues and healthy organs require healthy cell membranes. In addition, LDL-C transports fat-soluble vitamins to your tissues and cells. Moreover, LDL-C is used by the body to synthesize adrenal and gonadal (testicular and ovarian) hormones. This is why some research demonstrates statin drugs contribute to testosterone deficiency in men, a known cardiovascular risk factor.

Recent published research found that both very low LDL-C (<70 mg/dL) were associated with an increased risk of all- cause, cardiovascular, and stroke mortality. Oppositely, the researchers found that very high LDL-C levels (≥190 mg/dL) were associated with increased cardiovascular and coronary heart disease mortality.

 

Go Mediterranean

There has been a lot of publications on the effectiveness of diet and cardiovascular disease prevention, especially the Mediterranean Diet (Med Diet). A 2019 study evaluated Italian adults with cardiovascular disease and the adherence to the Med Diet, and who may have been using statin drugs. Med Diet lowered the risk of all-cause, cardiovascular, and stroke without the use of statins. For the same group of people, statins reduced the risk of death only for those also following the Med Diet.

 

Personalized Medicine

For my patients I order advanced cardiovascular blood panels that go far beyond the typical lipid measurements. It is very important to know if the patient has abnormal lipid particle size (HDL and LDL), inflammation, nutrient status, hormone status, toxin status, and other factors that can be objectively measured for cardiovascular risk. In addition, for patients at risk I often order imaging to see the state of their arteries. For many of my patients’ diet and lifestyle, as well as supplements such as our Cholesterol Wellness and Bergamot Wellness are very effective in managing their condition.

 

Dr. Mark Stengler NMD, MS, is a bestselling author in private practice in Encinitas, California, at the Stengler Center for Integrative Medicine. His newsletter, Dr. Stengler’s Health Breakthroughs, is available at www.americasnaturaldoctor.com His clinic website is www.markstengler.com

 

References

Carpentier, Y., & Sobotka, L. (2008). Basics in clinical nutrition: Lipid metabolism. e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism, 3(5). https://doi.org/10.1016/j.eclnm.2008.06.005

Donati, M. B., de Gaetano, G., & Iacoviello, L. (2019). Interaction between Mediterranean diet and statins on mortality risk in patients with cardiovascular disease: Findings from the Moli-Sani Study. International Journal of Cardiology, 276, 248–254.

Byrne, P., Demasi, M., Jones, M., Smith, S. M., O’Brien, K. K., & DuBroff, R. (2022). Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment: A Systematic Review and Meta-analysis. JAMA Internal Medicine, 182(5), 474–481. https://doi-org.uws.idm.oclc.org/10.1001/jamainternmed.2022.0134

Centers for Disease Control and Prevention. (2022, October 24). High cholesterol facts. High Cholesterol Facts. https://www.cdc.gov/cholesterol/facts.htm

Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., Braun, L. T., de Ferranti, S., Faiella-Tommasino, J., Forman, D. E., Goldberg, R., Heidenreich, P. A., Hlatky, M. A., Jones, D. W., Lloyd-Jones, D., Lopez-Pajares, N., Ndumele, C. E., Orringer, C. E., Peralta, C. A. Yeboah, J. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APHA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. Journal of the American College of Cardiology, 73(24), 285–350.

Virani, S. S., Alonso, A., Aparicio, H. J., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Cheng, S., Delling, F. N., Elkind, M. S. V., Evenson, K. R., Ferguson, J. F., Gupta, D. K., Khan, S. S., Kissela, B. M., Knutson, K. L., Lee, C. D., Lewis, T. T., … Tsao, C. W. (2021). Heart disease and stroke statistics—2021 update. Circulation, 143(8). https://doi.org/10.1161/cir.0000000000000950.