Monday, October 10, 2016

Are There Alternatives to Statins?

Statins are the go-to therapy for lowering “bad” LDL cholesterol, but other treatments also can effectively reduce risk of future heart problems, a new evidence review reports.

These alternative therapies – including a heart-healthy diet, other cholesterol-lowering medications, and even intestinal bypass surgery – seem to confer the same level of heart health protection as statins when cholesterol levels decrease.

Nonstatin therapies reduced the risk of heart problems by 25% for each 1 millimole per liter decrease in LDL cholesterol levels. That’s very similar to the 23% reduction per 1 millimole per liter decrease seen with statins like atorvastatin (Lipitor) and simvastatin (Zocor), the researchers said.

What’s more, the benefits of these therapies stack up if more than one proves effective at lowering a person’s cholesterol levels, said senior researcher Dr. Marc Sabatine, a cardiologist at Brigham and Women’s Hospital in Boston.

“The focus really should be not on a particular drug, but on reducing LDL cholesterol,” Sabatine said. “These data show there are multiple interventions that can do that.”

Statins, which work by reducing the liver’s production of cholesterol, were taken by more than one-quarter of U.S. adults aged 40 and over during 2011-2012, according to a national survey.

A heart-heathy diet reduces the amount of LDL cholesterol you eat while increasing dietary components like fiber has been shown to help clear cholesterol from the bloodstream.

Zetia (ezetimibe), is a drug that blocks absorption of cholesterol in the digestive tract.

Bile acid sequestrates encourage the liver to draw more cholesterol from the blood stream and convert it into bile acids.

Ileal bypass surgery shortens the length of the small intestine by bypassing its final section. Again, this promotes the conversion of cholesterol into bile acids by the liver.

These treatments have different levels of effectiveness in lowering LDL cholesterol, the study found. Zetia reduces cholesterol by about 20%, stains by 30-50% depending on dose, and PCSK9 inhibitors by as much as 60%, Sabatine said.

But the different trials showed that each unit of LDL cholesterol removed from the bloodstream protects heart health, regardless of how doctors are able to drive those cholesterol levels down.

The study findings were published Sept. 27 in the Journal of the American Medical Association.

My Take:
Finally a study that doesn’t promote a statin deficiency as the cause of all heart disease. However, with the exception of the heart healthy diet, none of the other options appear to be better choices. In fact, Zetia is often prescribed in concert with statin drugs to really drive the LDL cholesterol down.

The key is not to “drive the LDL cholesterol down” but to reduce inflammation and the LDL cholesterol will drop in response. In fact, this retrospective study seems to fly in the face of other recent studies that showed driving the LDL cholesterol down below 99 had no additional benefit over just reducing it to 99.

The Bottom Line:
The pendulum is beginning to swing. Fats are no longer bad and we are allowed to talk about alternatives to statins. Much has been written about the skewed data used to support statin therapy. The Lancet, a British medical journal, published research indicating that statin drugs have significant side effects (like cardiac myopathy) in up to 20% of patients. When Big Pharm has made enough money and they see the writing on the wall, we will slowly move away from statin drug therapy.

Source: September 27, 2016 National Institutes of Health

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