Ask the Nurse

I recently read a newsletter that featured a section on lowering one’s LDL and it recommended the use of statins. However, and given this is a newsletter specifically focused on women’s health, it has been my understanding that there has been no good research results to date linking the use of statins to lower LDL in women and the prevention of heart disease. I have had high LDL since my early 30s, and despite the fact that I eat almost no saturated fat and I exercise frequently and rigorously, it has not gone down. I did go on a statin for a while, but felt some muscle weakness, which I did not want to tolerate, as I felt it was interfering with my workouts. Because of my concern and because I could find no good evidence for the use of statins in women, I discontinued its use. I would love to hear your opinion and that of other medical professionals from the Center for Women’s Health on this issue. Thank you.

It has been proven that use of statins does indeed lower your risk of cardiovascular disease. Risk and benefit has to be considered before using any medication. According to the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), individuals’ risk factors along with their Framingham Risk Score should be considered when determining what their goal LDL should be.

Your total cholesterol consists of triglycerides, HDL (which is considered your good cholesterol) and LDL (which is considered your bad cholesterol). The LDL value is what is targeted to reduce an individual’s risk of heart disease. So, let’s first begin with risk factors.

Risk factors that are cardiovascular disease equivalent:

  • Clinical Cardiovascular Disease (CVD)
  • Symptomatic carotid artery disease
  • Peripheral arterial disease
  • Abdominal aortic aneurysm
  • Diabetes

Major risk factors:

  • Cigarette smoking
  • Hypertension (blood pressure less than 140/90mmHg or on antihypertensive medication)
  • Low HDL cholesterol (40mg/dl)
  • Family history of premature CVD (CVD in male first degree relative which is a father or brother at age 55 or younger or CVD in a female first degree relative which is a mother or sister at age 65 or younger)
  • Age (men 45 years old or older and women 55 years old or older)

According to the ATP, if an individual has at least two risk factors without CVD or CVD equivalent, then the next step is to determine their Framingham Risk Score (FRS).

Framingham Risk is a risk assessment tool to predict a person’s chance of having a heart attack in the next 10 years. The tool is designed for adults 20 years of age and older who do not have heart disease or diabetes, which is a CVD equivalent.

Framingham Risk Score uses the following to predict your risk of a cardiovascular event over the next 10 years:

  • Age
  • Gender
  • Total Cholesterol
  • HDL Cholesterol
  • Smoking status
  • Systolic blood pressure (which is the top number of your blood pressure)
  • Current use of medications for high blood pressure

Dr. Oz talked about a test called hsCRP and the risk for heart disease. hsCRP is a blood test that is used as an indicator of inflammation in your blood stream, which is not specific to the heart. It can be used to monitor diseases such as rheumatoid arthritis and lupus.

There was a study done called, Jupitor that was based on the theory that statins lower levels of hsCRP and cholesterol. So researchers decided to treat people with high hsCRP, but without high cholesterol they might benefit from statin therapy. The study included men older than age 50 and women older than age 60, with no history of CHD, LDL less than 130, hsCRP greater than 2.0 and Trig less than 500.

People were excluded if they had DM, uncontrolled HTN, severe arthritis, long-term steroid use, use of hormone replacement therapy (HRT) or previous use of lipid lowering medication. The study showed that there was a decrease in LDL by 50 percent, a decrease in hsCRP by 37 percent and a significantly reduced incidence of major cardiovascular events in these men and women.

However, keep in mind that the majority of the individuals enrolled in this study did not meet ATP guidelines for treatment with lipid lowering medication to begin with.

There is also the Reynolds Risk Score which some believe is more accurate at detecting the risk of CVD in women versus the Framingham Risk Score. Similar to the Framingham Risk Score, the Reynolds Risk Score is only useful if there is not a history of diabetes, which is a CVD equivalent. Similar to FRS it takes into consideration the following:

  • Age
  • Systolic blood pressure
  • Smoking status
  • Total cholesterol
  • HDL level

The difference between the two is the use of the hsCRP and family history.

I would encourage you to further discuss your risk for CVD with your provider based on the information above and if the benefits of a statin outweigh the risks. I hope this information was helpful.

All My Best,
Speaking of Women's Health Nurse

July 17, 2013 at 10:20am