How to use statins to manage cholesterol


Are statins really a miracle drug for people at risk for heart disease? Should everyone take them? Dr. Suzanne Steinbaum, director of Women and Heart Disease at Lenox Hill Hospital, explains what you need to know about statins.

How to use statins to manage cholesterol
Are Zocor and Lipitor—brand names for statins—really the miracle drugs that advertising says they are? Maybe...

Here's what you need to know:
  • Statins are a group of drugs that reduce LDL ("bad") cholesterol, slightly increase HDL ("good") cholesterol, and may help with diabetes. By decreasing inflammation and changing cholesterol patterns in our arteries, they stabilize plaque and decrease the risk of heart disease.
  • As with any medication there is a small risk of side effects from statins, including muscle aches. And if you start a statin regimen, you need to initially have your liver enzymes checked every six weeks. Once you know you can tolerate statins with no side effects, you can take them almost indefinitely to prevent the onset and progression of plaque and heart disease.
  • Statins do not take the place of exercise and a prudent diet. For optimum heart health you need to continue to eat right—low fat/low cholesterol/high fiber foods. A prudent diet is also important for controlling triglycerides, another risk factor in heart disease. Substitute multi-grain foods, fruits, vegetables, legumes and foods with omega 3 fatty acids for pastas, white bread and simple sugars to increase your HDL and lower both inflammation and your triglycerides. Your physician may also want to add niacin, a prescription vitamin, to your diet.
  • While statins can be prescribed by any physician, it is important to consult with a cardiologist if you have any pre-existing risk factors for heart disease—high blood pressure, high cholesterol, smoking, family history of heart disease at an early age, diabetes, obesity or a sedentary lifestyle.

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I'm Lisa Birnbach for Howdini. By now, you've probably seen about a million ads for anti-cholesterol drugs like Lipitor and Zocor. They will help lower cholesterol as we understand it, and they may even be helpful with other health problems, like diabetes. But as the ads always say, we feel we should ask our doctor if statins are right for you. And our doctor, in this case, is Suzanne Steinbaum, a cardiologist who specializes in women's heart disease at Lenox Hill Hospital in New York.


Dr. Steinbaum, what are statins?


Statins are a group of drugs that have been shown to decrease LDL cholesterol, which is the bad cholesterol, and actually increase a little bit the HDL cholesterol, the happy cholesterol.


Why aren't we all taking them as a matter of course?


I think at some point we might actually ask ourselves that question. Statins, in some way, seem to be a miracle drug. They not only change the cholesterol pattern but they actually decrease inflammation and stabilize plaques. We know heart disease is due to plaque formation inside of the arteries. There's cholesterol and inflammatory cells, and they all group together in this little mound, if you can picture it, inside of the artery.


When you have a heart attack, picture a pot of boiling water on the stove filled with soup. And inside that pot, all of those different particles-- cholesterol particles bubbling away, something called smooth muscle cells, inflammatory cells. And picture that pot covered with--


Mmm, yum!


No, no. Covered with Saran wrap. You cut the Saran wrap, and steam comes out, and particles come out. And that's what happens when you have a heart attack. Those statins stabilize that Saran wrap, keeps the bubbling down. It's an anti-inflammatory, along with being a lowering of cholesterol.


Are there bad side effects to statins?


It's very important to know that every medication can have a side effect, and it depends on you. Some people do get muscle aches with statins, and it's important to get your blood checked. The statins are metabolized by the liver, and the liver enzymes need to be checked, in the beginning, every six weeks. And if everything is OK, then they can be checked less often.


Eventually, if you find the right statin with the right formula, you can go on it indefinitely.


Absolutely. And it in fact may prevent the progression of that plaque formation.


But don't think of the statin as your excuse to not exercise.


A statin does not replace exercise.


I'm sucking up to you now.


A statin actually does not replace your need to eat well, either. You can't take your statin and go have a hamburger with cheese. It in fact is not the way it works. You need to continue to eat well and eat appropriately, in terms of a low fat, low cholesterol, high in fiber diet to actually prevent the onset and progression of heart disease.


Do people watching who think that they want to start on statin therapy, do they need to go to a cardiologist, or can their general practitioner put them on it?


Statins can be prescribed by anybody. But I think it's important that we understand what our risk factors are, and understand if, in fact, we might be at risk for the development of heart disease. When cholesterol is assessed, we don't just look at the LDL cholesterol, which is really when we put somebody on a statin. We look at multiple other components. The HDL cholesterol, the good cholesterol, we know is protective.


And in fact, a statin is not the best way to increase our cholesterol. I hate to say it, but exercise is the best way to increase the HDL cholesterol. Along with a vitamin that is called a niacin. Niacin, in certain formulations, are FDA-approved, and a prescription is required as well. That medication increases the HDL cholesterol and helps protect the heart.


The other thing is triglycerides. Now this type of lipid is actually something that's very directly related to our diet. If you have a diet filled with breads and pastas and simple sugars, triglycerides tend to go up. The best way to get triglycerides down is actually by eating a diet filled with lots of multigrains, and also substances that are high in antioxidants. Fruits, vegetables, legumes, all of these things. The Mediterranean-type diet is the best way to decrease triglycerides. But also, omega-3 fatty acids are very important, and can decrease triglycerides, increase HDL cholesterol, and also decrease inflammation.


Thank you so much.


You're very welcome.


For Howdini, I'm Lisa Birnbach.

meet theexpert
  • Dr. Suzanne Steinbaum

    Dr. Suzanne Steinbaum Cardiologist, Lenox Hill Hospital, NY Dr. Suzanne Steinbaum is an attending cardiologist at Lenox Hill Hospital in New York City. She is often cited in magazines and newspapers and is regularly seen on network news health segments for ABC, NBC and CBS. more about this expert »

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