By Dr. Willie Ong

Linda, a plump middle-aged lady was distraught with her cholesterol level of 273 mg/dl, which was 73 points over the normal limit. Although she did not feel anything, she was worried about having a heart attack. A friend advised her to take a statin drug. Should she take it?

The Evidence

Simvastatin, atorvastatin and rosuvastatin belong to a class of drugs called the statins, which are very effective in lowering cholesterol levels. But first things first, does she really need it?

Most doctors follow the time-tested National Cholesterol Education Program (NCEP) guidelines for the treatment of high cholesterol. In layman’s terms, the recommendations are as follows:

For persons with a total cholesterol of more than 280 mg/dl or an LDL cholesterol (the bad cholesterol type) of greater than 190 mg/dl, drug treatment may be started after (a) an eight-week trial of diet and exercise and (b) confirmation of cholesterol levels beyond the above cut-offs.

For those persons who have heart disease, hypertension or are heavy cigarette smokers, drug treatment is started at a much lower cholesterol level of 240 mg/dl and higher or an LDL cholesterol of more than 160 mg/dl.

And for those who have diabetes or have already suffered a heart attack or stroke, they are the ones who would most benefit from the statin drugs, even if their cholesterol levels are just a shade over 200 mg/dl.

Steps for Cholesterol Treatment

1. Check the accuracy of the test.

First, cholesterol test results are notoriously inaccurate, unless it is taken from a reputable laboratory. Second, make sure the 12-hour fasting requirement is followed – no food and just a minimum of water before testing. For these reasons, a repeat test after 1-2 months of diet and exercise may save the patient money and needless worry.

2. Emphasize lifestyle changes.

Drugs are expensive and entail frequent monitoring for side effects. Thus, lifestyle changes should be maximized.

Concerning diet, patients are encouraged to increase their intake of fish and vegetables. Try replacing high-fat food items with low-fat options. Craving for full cream milk? Try skim milk. Yearning for pork fat? Try bangus belly fat. Also, practice boiling or broiling foods as opposed to frying. Likewise, increase your fiber consumption, such as apples, legumes, and grains, since fiber removes the cholesterol from your body.

Aside from diet, exercise is very effective in lowering your bad LDL-cholesterol and increasing your good HDL-cholesterol. A general increase in physical activity is encouraged. The best exercise is still brisk walking, 5 times a week for about an hour.

3. Drug treatment options for your budget.

If diet and exercise fail (meaning your cholesterol levels are still above the cut-off levels), then the best drugs around are the statins. At the high end, we have Atorvastatin 20 mg, which costs P70 per tablet, taken 1 tablet daily before bedtime. Those with a moderate budget can take Simvastatin 20 mg at night.

If these options are still too expensive, then one can take just a half tablet and see if it works. Recently, there are studies which experiment on a 4 times a week dose of these statins. But the jury is still out if this is good enough.

A common question is: How long should I take statins? Studies show that statins should be taken for 3 to 5 years to reap lasting benefits. Popping a pill after eating a T-bone steak may remove the guilt but not the fat.

And for those with a low budget, the Lancet journal suggests taking an aspirin, which it dubbed as the “poor man’s statin.” Aspirin at 80-160 mg a day should be taken after meals to avoid stomach upset. Many doctors also combine statins with aspirin as these drugs have added health benefits.

4. Natural treatment options.

For those with an aversion to drugs, there are natural options available. Garlic at 1-2 cloves per day, preferably raw or in capsule form, can reduce cholesterol by 9-12%, although bad breath can be an embarrassing problem.

The well-studied Omega-3 fish oil also lowers one’s cholesterol and has numerous other health benefits. Omega-3 helps protect the heart, prevent heart attack and balances cholesterol.

Presented with the above options, Linda agreed to religiously diet and exercise for two months. If she fails, then treatment with statins and fish oil is planned. Good luck to Linda and all those with cholesterol problems.

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