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January 22, 2013

Case Studies
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Case Study: Discontinuing Statins After 17 Years

Before discussing this particular case study, it is important to “set the scene” and discuss both cholesterol and statins.

Why Cholesterol is Good

85% of cholesterol is produced endogenously (in the body). Therefore, we turn the production of cholesterol on and off as needed.

Cholesterol plays many important roles in the body:

  • Cholesterol is used to form cell membranes
  • Cholesterol is a building block for vitamin D and steroid hormones
  • Cholesterol acts as an antioxidant
  • Bile acids are derived from cholesterol
  • Our skin is protected by cholesterol
  • Cholesterol compensates for changes in membrane fluidity

Many people have been conditioned to think that cholesterol is the “bad guy.” We have been told that, over time, arteries can get clogged with cholesterol and, therefore, we must reduce cholesterol by any means necessary to avoid developing cardiovascular disease (CVD). The “any means necessary” usually results in cutting cholesterol-containing foods out of the diet (like egg yolk) and taking a statin.

Statin: Cholesterol-Lowering Drugs

Statins are one of the top selling classes of drugs. Annual sales of these drugs now exceed $25 billion (the “b” is not a typo). Prescription after prescription are filled, with the hope of reducing heart disease. Research is showing, however, that these drugs are not doing exactly what they say they do. Here are what some recent studies found:

  • Statins did not reduce total heart attacks or strokes in 10,990 women in the primary prevention trials. 1
  • Statins did not reduce total heart attacks or strokes in 3,239 mean and women older than 69. 2
  • There was no difference between the randomly chosen treatment group receiving statins and the control group receiving a placebo in the rate of death, heart disease, and heart attack. There were 10,355 people included. 3
  • The was no correlation between lowered LDL cholesterol and death rate during a study of 47,294 patients without CVD. 4

     

The other issue with statins is that they block an enzyme (HMG CoA-Reductse) which is responsible for the production of both cholesterol and coenzyme Q10 (CoQ10). CoQ10 is required in large amounts by the liver, brain, and heart to carry out energy production. Some of the serious side-effects of statin-use have been related to low levels of CoQ10. 5 6J. Abramson and J. Wright. Are Lipid-Lowering Guidelines Evidence-Based?. Lancet 369 (2007):168-169.

Susan: High Cholesterol

I had been working with Susan on a number of other issues and I had mentioned many times the possibility of normalizing cholesterol with diet, lifestyle, and supplements.

Susan finally decided that she was ready to do a trial to see if her cholesterol could, in fact, be controlled without pharmaceuticals.

Before embarking on this protocol, I wanted to assess the actual risk of Susan developing CVD. After all, this was her main concern which can sometimes be forgotten.

I evaluated a number of risk factors for cardiovascular disease (not all included below):

  • Obesity: Susan had a BMI in the healthy range between 18.5–24.9
  • Smoking: Non-smoker
  • Low vitamin D: In the optimal range (see below)
  • Low vitamin K: Deficiency not suspected from symptomatology
  • Exercise: Daily
  • Genetics: Father has CVD
  • Elevated C-Reactive Protein: Negative (see below)
  • Elevated Homocysteine: Not in optimal range of &<6mmol/L (see below)

The Functional Approach

I explained to Susan that although she exercised, ate a predominantly organic whole-food diet, meditated, and had few other risk factors, there were a couple of things of concern. First, homocysteine levels were high and this metabolite could compromise the repair and maintenance of the endothelial lining of the arteries. Second, since statins have been shown to have side-effects, I would help her achieve her goal of coming off statins.

The following recommendations were made in addition to her supportive dietary and lifestyle habits:

  • Fish oil
  • Niacin
  • Plant Sterols
  • Folic Acid (MTHF)

Within about 6 months cholesterol levels were normalized and Susan remains off statins.

Great work Susan!

– Josh

(Please note: the above case study is only meant to show you the possibility of using functional medicine as a means of achieving optimal health. Not all details have been included. Before embarking on a health program, it is recommended that you seek the guidance of a competent health care practitioner.)

References:

  1. J.M.E. Walsh and M. Pigame. Drug treatment of Hyperlipidemia in Women. JAMA 291 (2004):2243-2252.
  2. J. Shepherd, G.J. Blauw, M.B. Murphy, et al. Pravastatin in Elderly Individuals at Risk of Vascular Disease (PROSPER): Aradomized Controlled Trial. Lancet 360(2002):1623-1630
  3. ALLHAT Officers and Coordinators for ALLHAT Collaborative Research Group, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major Outcomes in Moderately Hypercholesterolemic, Hypertensive Patients Randomized to Pravastatin versus Usual Care. JAMA 288(23):2998-3007
  4. N.Nakaya, T. Kita, H. Mabuchi, et al. Large-Scale Cohort Study on the Relationship between Serum Lipid Concentrations and Risk of Cerebrovascular Disease under Low-Dose Simivastatin in Japanese Patients with Hypercholesterolemia: Sub-Analysis of the Japan Lipid Intervention Trial (J-LIT). Circ J 69(9)(2005):1016-1021.
  5. G.P. Littarru and P. Langsjoen. Coenzyme Q10 and Statins: Biochemical and Clinical Implications. Mitochondria 7(Suppl.)(2007):S168-S174