Healthy lifestyle changes can reduce the need for statins

Q: Would you comment on some information I’ve discovered about statin drugs that I think reveals some nefarious numbers on behalf of the drug companies?

So far I’ve found two reports that say the actual number of people who have heart attacks after being put on Lipitor has gone down from 3.1 percent to 2 percent. This was a study of thousands of people over 10 years and was done by the drug company, not an independent lab. The pharmaceutical company that sells the statin drug claims a reduction from 3 percent to 2 percent translates to a 33 percent drop.

I have a different opinion. If my odds of having a heart attack go from 3 percent to 2 percent, I’ll say that’s a 1 percent decrease. So I stopped taking the drug because of the long-term side effects. I’ve also changed my diet to eliminate sugar and highly refined carbohydrates, and I’m eating lots of dark green vegetables. I keep my weight under 140 pounds, which is still a few pounds over my natural weight (about 135 pounds). I’m 5 feet 9 inches tall and have always been very skinny.

I had a heart attack and triple bypass 11 years ago even though my blood pressure was 125/80. My current cardiologist wants to increase my statin medication from 40mg to 80mg. I am 78 years old and very healthy.

Anonymous

A: An old saying goes that there are three kinds of lies: lies, damned lies, and statistics. What you call nefarious, the drug company calls marketing, and both views are true as long as you understand what is being said.

The original study, which looked at the effect of a statin drug in people with heart disease, showed that the risk of death at 5.4 years was 12 percent in the group randomly assigned to a statin and in the group randomly assigned to a placebo assigned was 8 percent. The paper called that a 45 percent relative risk reduction, but I would call it a 4 percent absolute risk reduction. Other studies (there have been many that have consistently shown benefits) haven’t shown as much of an improvement (33 percent relative risk reduction is more common than 45 percent), but you need to consider both the duration of a study and how ill the study participants are.

You may still think that going from a 12 percent risk of death to an 8 percent risk of death over five years isn’t worth taking the drug. I know which group I’d rather be in, so I would recommend a statin for someone who is at such high absolute risk. I would never recommend a statin to a person with an absolute 10-year risk of 3 percent. Most authorities recommend a statin once their 10-year risk is above 7.5 percent.

You address long-term risks. Muscle pain leads many people to stop taking statins (who then have an increased risk of heart attack compared to those who continue to take statins), but persistent symptoms after stopping are rare.

People at high risk of heart attack and stroke benefit from statin therapy, but the amount of benefit depends on their risk. Those with a history of heart attack or bypass transplant are at high risk and are likely to get much more benefit than harm from a statin. People without a history of heart disease have less absolute benefit, so careful assessment, including evaluating lifestyle aspects such as diet and exercise, is crucial. I’ve had many people who no longer meet the criteria for a statin after making some healthy changes in their lives.

Q: I have struggled with IBS and GERD since childhood. I have had multiple gastroscopies and have taken countless medications over the years for my issues. I’ve followed every diet and lifestyle change my doctor suggested, with moderate results at best.

A friend recently suggested that I have my gut flora checked by a private company for analysis. This company takes your results and suggests a prebiotic regimen to improve your gut microbiome. However, these tests are expensive, and I am wary of spending $200 or more on a test kit that may not be as valuable as these companies claim.

Online reviews appear to be mixed, with some sources raving about their effectiveness and other sources saying these tests are limited in scope and of dubious value. What is your opinion on private gut flora screening at home? Is it worth?

NO

A: There’s a lot of excitement surrounding the microbiome (the term for the “suite” of thousands of bacterial species in your gut), but still a lot of uncertainty. Experts estimate that 40 percent of the genes identified in the microbiome have an unknown function. There is no consensus on what constitutes a “healthy” or an “unhealthy” microbiome. It’s also not clear whether an “unhealthy” result on your microbiome test is the cause or consequence of gut disease. It’s also very unclear that trying to manipulate a specific microbiome outcome through diet or probiotics yields better results than general healthy eating advice.

I rely on evidence, and the evidence that your $200 in testing will lead you to better health is not strong enough to recommend at this time.

Q: My recent DEXA scan showed I have a 19 percent chance of a major fracture within the next 10 years. Does that mean I have an 81 percent chance of not having a major fracture?

MEH

A: Yes, that’s exactly what it means, but you should be aware that your risk will continue to increase after the 10 years. If you’re one of the lucky 81 percent who don’t break a hip, you have a much higher chance of breaking a major bone in the years to come.

Most authorities recommend treatment when the risk of a major osteoporotic fracture exceeds 20 percent, but not everyone will choose therapy at this level. The higher the risk, the greater the benefit from treatment, which includes diet, exercise, vitamin D, and sometimes medication. Treatment reduces fracture risk. In women with very low bone density, six out of 100 women who took the medicine for three years didn’t have any fractures that it would have otherwise had.

All drugs have downsides, and bisphosphonates (the most common class of drugs; Fosamax is one of them) increase the risk of several problems, including osteonecrosis of the jaw. These drugs should only be used when the clear benefit outweighs the risk and the 20 percent threshold is a commonly used guideline.

Q: What are some natural ways to lower blood pressure?

JW

A: Too often, doctors jump to drug therapy to control blood pressure when there are non-drug options for lowering blood pressure that are often overlooked.

Not every person with hypertension is sensitive to salt, but overall, reducing salt levels can produce a significant improvement in hypertension — an average of 5 points systolic and 3 points diastolic with moderate salt restriction. Other dietary changes shown to improve high blood pressure include foods high in potassium, such as fruit; a more plant-based diet with more vegetables and legumes and less meat; and higher levels of calcium and magnesium in the diet.

Alcohol can have an extremely damaging effect on blood pressure in many people, especially the day after drinking three or more drinks. Smoking also raises blood pressure, and quitting has many health benefits beyond the drop in blood pressure. Regular, moderate-intensity exercise (40 minutes three or four times a week) similarly improves blood pressure.

There is evidence supporting the benefits of some dietary supplements. One study of aged garlic supplements was methodically strong, showing an average 5-point decrease in systolic blood pressure. Smaller studies have shown benefits with the supplements berberine and whey protein. Dark chocolate and decaffeinated coffee/tea have minor beneficial effects.

Finally, some types of meditation have been shown to help lower blood pressure. Slow, deep breathing techniques can also temporarily lower blood pressure.

Not everyone with high blood pressure can avoid medication with these natural remedies, but there are many who can, and many of these natural remedies have additional health benefits beyond blood pressure.

dr Roach regrets that he cannot reply to individual letters, but will include them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or mail them to 628 Virginia Drive, Orlando, FL 32803.

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