The headlines in medical journals this month have been scary for anyone on cholesterol medication: ‘How statistical deception created the appearance that statins are safe and effective in primary and secondary prevention of cardiovascular disease,’ said one. Another said, ‘LDL-C does not cause cardiovascular disease (CVD): a comprehensive review of current literature’. Indian cardiologists don’t go by either of these studies, and say that cholesterol still is a major cause of CVD and that statins are still the mainstay of treatment.
Cholesterol is…
Cholesterol is actually needed by the body: it’s a building block in cell membranes and helps in the making of certain hormones, playing a crucial role in spermatogenesis (the process of sperm production). About 80% of the cholesterol needed by our bodies is produced by the liver and only about 20% comes from food. Unfortunately, cholesterol from food still has a bad reputation, but the nutrient has been removed by the US from its list of ‘nutrients of concern’. While you don’t have to go nuts about measuring out your life in ghee spoons, you do need a balanced diet. It’s true that cholesterol is an artery-clogging substance which has the potential to cause a heart attack.
There’s a difference…
Dr VK Bahl, who heads the cardiology department at AIIMS, Delhi, explains that high cholesterol has been seen even in early childhood and heredity plays a role. High levels of low density cholesterol (LDL) can lead to plaque formation in the blood vessels of the heart, medically termed atherosclerosis. Over time, this plaque can harden, and if more than 70% of the vessel is blocked, it can lead to cardiovascular diseases (CVD). This plaque can also rupture and cause damage to the heart vessels, resulting in a stroke. However, high density cholesterol (HDL) is good for the body.
There are other factors too…
The Indian Heart Association says that the optimal LDL cholesterol is 100 mg/dL and HDL is 40 mg/dL. “People with high LDL are usually advised to make lifestyle changes, diet plans, start exercising, quit smoking, and drink wisely. If there is no change even after these interventions, and/or if there is a family history of cardiovascular diseases, we advise medications, especially statins,” explains Dr Suman Bhandari, Chief Cardiologist at Fortis Hospital, Noida.
“There is a mix of risk factors for cardiovascular diseases. High cholesterol is just one of them. A lot of unwanted WhatsApp messages have created false information and are misleading the public. We have started many community outreach programmes to educate the public,” says Dr K Kannan, President of the Cardiological Society of India: Chennai Chapter.
What’s changed…
Heart disease is not caused by cholesterol alone. It is also about exercise, our stress levels, eating patterns, whether we smoke, how much alcohol we drink, and overall lifestyle.
“Earlier the management strategy depended solely on total cholesterol or LDL cholesterol level. But now it depends on the future risk also,” explains Dr D Prabhakaran, Vice President (Research and Policy) and Director, Centre for Control of Chronic Conditions at the Public Health Foundation of India. Depending on the absolute level of cholesterol, family history, diabetic status, life style habits, patients are scored and grouped into low, intermediate and high risk group.
Low risk group are usually asked to change their foot habits, exercise and then do a recheck, while the other two groups are given required doses of statins.
People who have CVD may be asked to control their LDL to 50 or 70 mg/L, depending on age and other risks, says Dr JPS Sawhney, head of the cardiology department at Sir Ganga Ram Hospital, in Delhi. Also, for the 10% of patients who show a statin intolerance and exhibit myalgia (muscle pain usually in the calves), there are are drugs available.
There’s a small risk…
“In a tiny proportion of patients, statins can cause acute liver damage or destroy muscles. But this is extremely rare. The side effects can be managed through simple measures such as withdrawing statins, reducing the dose, replacing with a different variant of statin.” However, once you start a statin course, it should be continued regularly to keep the risk at bay.
