Lifestyle can do as much as drugs can do for hearts

September 2, 2008

Lifestyle can do as much as drugs can do for hearts

Posted to the web on: 27 August 2008

Statins can be a mixed, rather than a miracle, blessing to protect your heart by keeping bad cholesterol in check. Lifestyle modification can sometimes work just as well, without the bad side effects, writes ASHLEIGH CARADAS

CARDIOLOGY

YOU know high cholesterol causes heart disease, right? And that reducing cholesterol with prescription drugs is a sure way to prevent a heart attack?

The answers are not a simple yes. Research shows that lifestyle factors play a large role in heart disease prevention, and lifestyle modification can help most people lower cholesterol levels, without medication.

It�s also true that heart disease is a complex process that involves a number of risk factors, high cholesterol being just one of them.

A data set of almost 30000 South African employees in the corporate sector published by employee wellness company HealthInSite in 2007 showed that 3,2% suffered from heart disease. Risk-factor assessment revealed that 48,2% were overweight or obese, 30,7% smoked , 50,3% led sedentary lifestyles and only 8,1% of employees screened had high cholesterol.

In SA and worldwide, pharmaceutical drugs called statins are routinely prescribed to reduce cholesterol and heart-attack risk. There are currently about 400000 people on statins in SA and about 30-million worldwide. Scientists and doctors have described statins in hyperbolic terms as �miracle� and �wonder� drugs. Other experts take a very different view.

UK nutrition specialist and author Patrick Holford is founder and director of the London-based Institute for Optimum Nutrition. He says statins are over-prescribed and potentially harmful. �It�s common sense that heart disease is a consequence of poor diet and lifestyle factors, not a deficiency of statins,� says Holford in his book, Food Is Better Medicine Than Drugs (Piatkus Books). Giving the drug to so many millions of people fails to address the true underlying causes of heart disease, which are largely lifestyle based and can be remedied through diet and lifestyle modifications, he says.

Holford says nutritional supplements, including vitamin C, fish oils and the B vitamin, niacin, can often do as good a job of lowering cholesterol without the risks of statin drugs.

To understand why, it helps to know something about the mechanisms behind a heart attack.

A heart attack is an ischaemic event in which the blood supply to the heart organ is cut off (in the case of a stroke, it�s the brain�s blood supply that is blocked). The leading cause of heart disease is atherosclerosis, or hardening of the arteries. Cholesterol build-up is one way of blocking an artery, but not everyone with high cholesterol will suffer a blocked artery.

University of the Witwatersrand endocrinologist Prof Derick Raal says cholesterol, smoking, high stress levels, diabetes, high blood pressure and central obesity are common risk factors in heart disease. Smoking, high blood sugar and stress can damage blood vessels, making them more susceptible to cholesterol build-up; high blood pressure can force cholesterol onto the walls of the arteries, he says.

He says around one in every 10 South Africans has high cholesterol (defined as a total cholesterol of above five millimoles/litre). About one in every 500 people in SA suffers from familial hypercholesterolemia � a hereditary form of high cholesterol (common in Jewish, Afrikaans and Indian populations), in which the liver overproduces cholesterol.

According to Raal, familial hypercholesterolemia presents with cholesterol levels ranging from 10 to 20 mmol/l. At such high levels, even a child with no other risk factors could have a heart attack. In such cases, statins are always prescribed.

In non-familial high cholesterol, levels are usually lower ( 5,5mmol/l to 8mmol/l) and caused mainly by dietary factors � not a predisposition to produce more endogenous (existing in the body) cholesterol.

Statins lower the LDL fraction of cholesterol (also known as �bad� cholesterol). They block a key enzyme, HMG-CoA (3-hydroxy-3-methyglutaryl COA) reductase, linked to the liver�s production of cholesterol. This inhibits the liver�s ability to produce LDL (or bad cholesterol) and increases the number of the LDL receptors on the surface of liver cells, resulting in more cholesterol being removed from the bloodstream. The most widely used statins are atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor). They are prescribed in two ways, says Raal.

n For primary prevention: for people with no evidence of existing cardiovascular disease.

n For secondary prevention: for people diagnosed with cardiovascular disease. In someone who has already suffered a heart attack, any cholesterol level is too high and giving a statin post heart attack can reduce the risk of another one by 30%.

All of this begs the question of just how dangerous statins are, and are they dangerous enough to advise people to try natural alternatives first?

In his book, Holford warns of many dangers and side effects associated with statins, including digestive complaints, liver damage and neuromuscular complaints. A continuing concern is that statins inhibit the production of coenzyme Q10, a vital heart nutrient.

Holford says statins can weaken the very organ they are trying to protect by lowering levels of this heart-healthy nutrient involved in the energy processes that regulate heart muscle function. Low levels of coenzyme Q10 can lead to fatigue and muscle pain and a deficiency exacerbates the side effects associated with statins.

A study in the American Journal of Cardiology in May 2007 showed that coenzyme Q10 supplementation reduced the severity of muscular pain in patients experiencing statin-induced myopathy. Holfor

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