Answering all patient's questions is key to continuing treatment compliance.

1. Are statin drugs really safe?

There are no other drug group that has been more studied than the 6 statin drugs - lovastatin, pravastatin, fluvastatin, simvastatin, atorvastatin and rosuvastatin.

No statin-induced death has been reported in any of the clinical trials.

Occasional muscle ache is the most common side effect reported in about 5% or less. It is not serious and reversible when drug is discontinued.

Liver enzyme elevation is rare - about 1 in 200. It is also reversible and does not result in permanent liver damage.

Intolerance to all 6 statin drugs is rare. About 98% of patients are able to take at least one of the six statin drugs. Intolerance to one brand of statin does not mean intolerance to the others. 

2. Why can't I wait a few years before taking statin? My brother had his heart attack when he was 60 and I am 45.

The ASCOT study demonstrated the onset of benefit with statin (blue) compared to placebo (green). The benefits of statin became manifest within months and increased with time. This study was supposed to last for 5 years but was prematurely stopped because 36% reduction of events was reached by 3 1/2 years.

The longer the duration of treatment, the greater the heart attack reduction.

3. Unlike my brother, I did not have a heart attack. Why do I need to take statin?

For your brother who already has heart disease, it is a case of secondary prevention. The 4S study addressed precisely this question - what are the benefits of statin therapy in patients with heart disease and the answer is clear. The benefits to your brother include 42% reduction in fatal heart attack, 37% reduction in need for future heart bypass and 30% reduction in stroke.

For you, it is a case of primary prevention. Study the slide below.

The AFCAPS/TexCAPS study consisted of healthy men and women volunteers from the Air Force. They were like yourself - in good health, without heart disease, with "normal" LDL cholesterol and slightly low HDL cholesterol. The study was designed to determine if this group of healthy patients will benefit from statin therapy compared to placebo.

The result - yes, they did benefit from statin significantly. Compared to those that received placebo, those that were given statin showed a 40% reduction in fatal heart attack, a 37% reduction in acute heart attack and a 33% reduction in the need for heart bypass!

4. Can't I lower my cholesterol using "natural" supplements instead of statin?

No other cholesterol lowering medications or OTC can match the benefits of statin drugs listed above.

Statin drugs have many other benefits that goes beyond LDL cholesterol lowering - so called pleotropic effects which also contribute to the reduction of heart attacks.

The natural method that the body removes LDL cholesterol from the blood is by the action of the LDL receptors in the liver.

Statin drugs cause the liver to produce more LDL receptors; thereby removing more LDL cholesterol from the blood and lowering LDL - in the above example from 150 to 65.

More other medications lower LDL cholesterol to the degree that statin does.

LDL receptors in the liver act like "Velco" -  LDL cholesterol floating in the blood sticks to them. Once they attached to the LDL receptors, they are taken inside the liver cells where they are processed.

More LDL receptors means lower LDL cholesterol.

5. Why do I need to raise by HDL? My LDL is already controlled.

Data collected from the Framingham Heart Study reveals that those with high LDL of 220 and normal HDL of 45 have the same risk as those with low LDL of 100 and low HDL of 25.

In high risk patients, untreated low HDL represents a residual risk after optimal treatment of LDL.

Unlike LDL cholesterol treatment, where 50 mg reduction is common, HDL raising is usually limited to much smaller quantity like shown above. But even small increases in HDL result in significant benefits. A 6 mg increase is accompanied by 50% risk reduction.

HDL's primary role is reverse cholesterol transport. HDL cholesterol removes cholesterol from the plaque and transports it back to the liver for elimination.

Raising HDL cholesterol has other beneficial effects as listed above.

6. It is true that cholesterol plaque regression is now possible?

HATS Trial showed that in patients with CHD, combination treatment consisting of statin and niacin, resulted in reduction in the degree of obstruction as shown by cardiac catheterization (yellow). Those patients with regression also had the largest event reduction of -89%! (yellow).

More recently, IVUS (intravascular ultrasound) has been used to directly examine and accurately measure the plaque as shown above.

In the ASTEROID Study, rosuvastatin lowered LDL cholesterol to below 70 mg/dl and raised HDL cholesterol by 14%. After 24 month, significant  plaque regression by IVUS was demonstrated.

A reduction in the degree of obstruction was also demonstrated in ASTERIOD Study.

There is an almost linear relationship between on-treatment LDL level and CHD risk. HDL raising and LDL lowering to less than 70 are associated with both plaque regression and much lower event rate.

Click here to see Dr. deGoma's lipid profile before and after treatment.