This article is a transcribed edited summary of a video Bob and Brad recorded in April of 2021. For the original video go to https://www.youtube.com/watch?v=IBmRHDPYRD4
Brad: Today we are fortunate to have Chris the pharmacist with us to cover statins for high cholesterol which helps prevent strokes and heart attacks. We are going to go into the side effects and the safe uses of these drugs. It’s very common, including Atorvastatin. This is going to give you all the information about statins. Things that if you are starting them or if someone you know is starting them and you want all the information you can find out about this and you forgot to ask the doctor or the pharmacist or you just didn’t have enough time because life is busy. This will fill you in! So, statins are for high cholesterol. What are these drugs and what are they doing for us?
Chris: Well, basically when people come into the doctor; whether they’ve had a heart attack or a stroke or maybe they’ve just had some routine lab work. They see repeated lab work where the cholesterol levels start creeping up.
Brad: So, they get the blood sample, and they measured your LDLs?
Chris: Yes, they do a whole lipid panel, so you are going to see your LDL, your HDL, your apolipoprotein A, and your triglycerides.
Brad: And the doctor looks at this and decides whether you’re a candidate or not for a statin?
Chris: Yes, they look at them very scientifically to determine if you are a candidate for drug A, B, or C.
Brad: So, statins is actually a broad term for how many drugs?
Chris: It is a class of drugs, and there are several. The first one that came out was lovastatin, and then they had simvastatin, both of which are made by Merck Pharmaceuticals. Then atorvastatin hit the market. That’s the largest-selling drug of the last 25 years, atorvastatin.
Brad: In the United States or worldwide?
Chris: As far as I know the United States. It’s like 94 billion in sales.
Brad: Wow. That’s all people being treated for cholesterol issues? Which then creates problems with your vessels, and your heart.
Chris: Yes. It’s going to protect them, it’s cardioprotective. Basically, it’s an insurance policy to protect you against stroke or heart attack.
Brad: So, your arteries don’t clog up.
Chris: Exactly. Some people, just to make it overly simple, it’s not like taking Drano, but it’s going to help keep your arteries clear. It works in a variety of different things, and we’ll pick on atorvastatin first. I would say it’s probably the most versatile. Rosuvastatin, Crestor, is probably the most potent.
Brad: So, this is a specific drug that a doctor may prescribe?
Chris: Yes, they are going to make some very specific choices as to what needs to be done because not only do statins help to reduce cholesterol, but they are also a natural anti-inflammatory, which is one of the added benefits of it for why it helps to keep those arteries clear. Let’s say it’s a bad scenario where you had a heart attack or a stroke and you were in the ER. They will probably plop you on a high-dose statin because they want to maximize the anti-inflammatory of it and more importantly the lipid profile aspects of it. To try and make sure that we don’t have this event occur again. It’s a very touchy time for patients when they are in a crisis situation. As we all know, heart disease is the number one killer for all of us and so when we use drugs like statin or atorvastatin in this particular case, we want to do that to keep them alive and well. These are pretty much, unless we have better science, these are drugs we will probably place on the rest of our life kind of thing.
Brad: If this is a problem with the arteries being clogged, is it that very directed to our diet, and can’t we change our diet?
Chris: Dietary changes are going to be absolutely massive in this whole healing effort. Let’s say you are just a patient that got your doctor saw a trend that your triglycerides and cholesterol were raising over time, or you were an acute patient that had a heart attack or stroke. Statins are going to be part of that mix. More importantly than any drug we could put in your body, the foundation of health is going to be eating well and exercising. At some point, there’s going to be a cardiac rehab portion of that equation to teach you to get into better lifestyle habits to stay healthy but the most important is nutrition. The problem with cholesterol is it’s a genetic problem. You can drink cholesterol by the gallon. It’s a big greasy molecule that you don’t generally absorb too much. Your body is generally making too much cholesterol in most cases. So, statins block an enzyme, HMG-CoA Reductase Inhibitor, that’s what statins are.
Brad: Ha-ha, thank you.
Chris: It’s a mouthful. It blocks that particular enzyme and there’s a big series of steps that goes on to make cholesterol, but it blocks it at that point. That’s why it helps to keep those arteries and vessels clear of cholesterol and plaque. What we want to do, and what all these statins do from one varying degree to another, is not only do they help to lower your cholesterol but they generally bring up your HDL, your good high-density lipoprotein, which is your good cholesterol.
Brad: So, if you have this, either you’ve had a stroke or a heart attack, you survived, you’re going to probably be on this medication. Or you see that rise and it’s a preventative thing, so you don’t have a stroke or heart attack.
Chris: Exactly. It’s like buying car insurance. You hope you don’t have an accident.
Brad: So, you’re going to change your diet, you’re going to get more exercise, and the doctor’s probably going to suggest this as well.
Chris: Yes.
Brad: I’m the kind of person who says, I don’t want to take these meds. Maybe I can just do it with exercise and diet. Is this a possibility?
Chris: It is a possibility. Let’s say you’re the patient that your doctor follows every year and you’re a good faithful patient, and they keep looking at your bloodwork and they see it creeping up and up, and then it might be time to say, “Okay, Brad, I see that your cholesterol levels are now in the medium 200’s. You’re sitting around 250, I think it’s about time we start to make a change so we can lower your risk for cardiovascular events.” You’re like, “Yeah, I’ve gotten off my exercise program, and I've been eating out a little more than I should.” You can definitely make a decision. I am going to start walking, running, or biking; do more yard work. You have to find a reason to be more active. Swim, it doesn’t matter. You need to do something. You have to move that body at least 30 minutes a day at least 5 days out of the week. You’re talking about 150 minutes a week you want to dedicate to that. However, you still have to put the right food in the machine too to make sure that you aren’t overdoing it. The doctor may say they like your plan and you can try to do these lifestyle changes and dietary changes and then revisit them in about 6 months. Then they’ll reach out and if you see the trend going in the right direction, God love you. We are going to keep you off of drugs. But not a lot of us get that lucky and there’s a genetic disposition kicking out too much cholesterol. Particularly the LDL and maybe our HDL isn’t as high as we need it to be because that’s kind of your scrubber. That’s the one that helps to keep plaque from building up. These drugs actually raise your HDL which helps as another protection like the anti-inflammatory effects. There are a lot of good things that happen for patients that are important to realize. If you’re resistant to taking medication; a lot of people go “gosh, statins, I’ve heard so many negative things about statins.” The incidents of side effects on statins, for the most part, is about 1%. So, 99 people tolerate these drugs unbelievably well. One person has a problem when we are talking about 100 people. Those side effects can range from a variety of different things. Doctors are watching these things very closely. They are watching your liver function. In three months, they are going to take a blood test to see that it’s doing its job and make sure your body is processing it properly. They are going to be looking at your renal functioning. Let’s say you’re someone who's got some kidney problems or something or there’s a genetic issue or a variety of different reasons.
Brad: That’s just a blood test?
Chris: Yeah. Your doctors will take care of all those things. All the things they don’t tell you about all the lab work. Now, with smartphones you can see all your lab work, it’s pretty slick. It’s nice to be informed. I really would tell you to get informed about your numbers. That’s something that you and your doctor can work with to make informed choices to see what the best course is for you. Not all statins are created equal. We picked on atorvastatin because it’s probably the most versatile of the bunch, but let’s say you need a little bit more HDL developed. Maybe rosuvastatin is a better choice. Here’s one of the reasons we are going to talk about it is grapefruit.
Brad: My favorite fruit. I am convinced; I don’t care what the research says but I know I eat grapefruit every day from November till April and during the season. I've been doing it for almost 10 years and since I’ve been doing it, I’ve never had a cold. I start to have one, scratchy throat but it never gets bad. I don’t know if it’s because of the grapefruit but I love it and I think it’s good for me. I’m not going to stop just because a doctor says I need statins.
Chris: You know what, that’s okay. Actually, with grapefruit, we say stay away from it with lovastatin, atorvastatin, and simvastatin. All the other ones, Fluvastatin, rosuvastatin, and pravastatin it's okay.
Brad: So, I can still enjoy my grapefruit?
Chris: Yes. That’s not off the table for people and some physicians and studies support even it’s the timing of eating grapefruit with your statin. I would tell you that the reason that we are so concerned with the interactions between grapefruit with statins, is it's going to increase your risk for muscle problems, myopathies.
Brad: So, that’s muscle pain?
Chris: Muscle pain and weakness. Rhabdomyolysis is the worst-case scenario. That can actually be fatal.
Brad: So, that’s a side effect or a possible side effect?
Chris: it could be a possible side effect of combining statins with grapefruit. Or even statins in and of themselves can cause it in very rare circumstances. But it’s a big deal. Basically, what it causes is programmed muscle cell death. What happens is muscle cells die off and then they ooze into your body and then it has to get metabolized out so it goes to your kidney and can cause acute renal failure. It’s a big deal. It’s very rare but when you come to your doctor or pharmacist, they say hey, watch out for unusual muscle pains or weakness. It’s not common but it is one thing to be a little stiff or sore if you’re raking your leaves or you’re shoveling your driveway, then you’ll have some muscle pain because you haven’t done that motion for a while. But if it comes out of the left field and you’re just achy and weak and don’t understand what’s going on, that’s the time when you really want to talk to your doctor. They are going to take a quick blood test and make sure it’s not overworking the liver. You heard me say that these are kind of rest of your life alternatives. There are things you can take besides that if you can’t tolerate statins. For the most part, usually just switching the statin from a different form to a different one because they have different metabolic pathways in your liver so that’s why grapefruit is tolerable with some but not others. We want to make sure that you don’t “just man up and take it” thinking you’ll be better in a couple of days. If it’s not getting better, you’re going to know, and you want to speak up. Talk to your doctor. It’s rare but serious. It’s a big deal. The reality of it is, when we try to take care of our hearts, it starts with the foundation. Sleep, exercise, and diet. Those are the 3 pillars that we always talk about. You want to make sure you’re getting your rest because that’s recovery. You want to make sure that you are eating well, even if you have to take these statins, even if you’ve had a heart attack, even if you’ve had a stroke, we need to find ways to do these things that our bodies will allow you to be able to do, so we can live the best way we can.
Brad: And did we talk about how many people in the US are on statins?
Chris: I don’t have a straight stat but there are millions of patients who are taking these things. Atorvastatin is by far and away the number one statin that is being prescribed. Rosuvastatin is used quite regularly.
Brad: Typically, what age do we see this more?
Chris: You’ll see it as young as in the 30s if there’s a genetic disposition towards cardiovascular disease. If you have heart disease in your family, doctors are excellent at screening for this now. When you go in for a physical these days, they usually have you fill out a 10-minute survey and they look at that very critically to see what your cardiovascular risk assessment is. They actually do that at a younger age now and they are finding they are getting some excellent results. They are starting early statin therapy or getting a better lifestyle earlier. We need you to exercise more and eat better. If you want to stay off these drugs, we need to start there. That’s your foundation. That’s critical. We hopefully can keep you off the medications but sometimes we can’t. So, if we can’t we are going to try and make sure you get the best choice. The big thing is, don’t be shy. Talk to your doctor. Have a good open dialogue. Your doctor just wants to help. They are there for you to help you live a better life. They aren’t just trying to collect a paycheck. They are beyond that. But sometimes things don’t work out of the gate so that conversation is absolutely critical. You can live the best way that you possibly can.
Brad: That’s the other thing. The information in this video may give you information to come up with good questions that are direct to the point and help make things more efficient because a lot of time the doctor doesn’t have a lot of time with each patient.
Chris: They don’t. I guarantee you every doctor on the planet would tell you they wish they could spend way more time with their patients. It’s their job, their drive, and the things that are driving the bus for them in this world are forcing them to make the best possible decisions and often time in 15-30 minutes. Sometimes that’s hard. There’s a lot to talk about. Especially if you’re coming in for your first visit post-heart attack or post-stroke, there’s a lot to discuss. The other thing too is an appointment. Always write your questions down before you see your doctor. I think that’s something that will help. I have these side effects; I’m either tired or dizzy. I feel achy. Make sure you write those down so they can address them one by one. That’ll help you to streamline the conversation too.
Brad: So many times, you’ll go in and you come back and say, I forgot to ask this question. A lot of people aren’t aware of particularly if it’s a medication problem, when you go to the pharmacist, ask your pharmacist your questions. I always think Chris could be a really good doctor.
Chris: Ha-ha
Brad: You’ve got everything for it, there’s no doubt about it. But the pharmacist has a lot of information that can be helpful too.
Chris: Yes, use your local pharmacist. They can answer those questions quickly and easily and
steer you in the right direction. They are going to point you in the right direction guys. We are often timing an untapped resource. Feel free to use us. Go to your neighborhood pharmacy. Strike up a conversation and develop a relationship. Those relationships are going to help you to live a better life so you can be a better version of yourself.
Brad: How long have you been at your store?
Chris: 16 years.
Brad: 16 years at the same store and you probably know people just from work.
Chris: I know one or two people. I know their kids; I know their grandkids now. I've been doing it for about 26 years. It’s nice.
Brad: Very good. I hope this makes you feel better about statins now. We’re going to go get something good to eat now.
Chris: Sounds like a good plan to me. Have a good day guys, thank you.
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