As a cardiologist, I see patients who present for chest pain, shortness of breath, dizziness, passing out, evaluation before any type of surgery, and all kinds of irregular or fast heart beats. When I evaluate a patient, regardless of the main reason for their presentation, I do everything I can to decrease their risk of developing cardiovascular disease.
Preventing cardiovascular disease involves assessing and tackling risk factors including family history, smoking, diabetes, high blood pressure, obesity, sedentary lifestyle and abnormal cholesterol and lipoprotein metabolism. Heart disease is when fatty deposits in the artery walls cause narrowing or blockage. Just imagine a pipe in your house that gets clogged over time.
LDL, the bad cholesterol!
Low-density lipoprotein (LDL) delivers fat molecules all over the body. If elevated levels are found in the body, it can form plaque, the stuff that can clog arteries and make heart attack and stroke more likely. Studies have found there is a direct relationship between the level of LDL in the blood and heart attack and stroke.
Lower your LDL with lifestyle modification
Diet and exercise, blood pressure and sugar level control, along with avoidance of cigarette smoking and second-hand cigarette smoke are the foundation of a healthy lifestyle. The Mediterranean diet has proven to be helpful in lowering LDL and the risk of heart disease. Components of this diet include multiple servings of fruits and vegetables, tomato-based sauces, whole grains, fish, olives and olive oil, nuts, red wine (2 glasses per day for men and 1 for women) as well as limited red meat and very few, if any, processed foods.
Statins discovered in 1970s
Therapy with statins such as Atorvastatin and Rosuvastatin (i.e. Lipitor and Crestor) has been shown to reduce LDL levels by approximately 25-40% and lowers the risk of coronary artery disease events by approximately 30%. The most common side effects, which are reversible with drug discontinuation, are muscle cramps, muscle inflammation, and asymptomatic liver enzyme elevation on blood testing. Diabetes and cognitive dysfunction have also been reported. Each person should monitor the effects of their medication and report any concerns to their doctor. A thoughtful discussion is warranted any time the decision is made to stop a medication.
In one of the world’s oldest and most prestigious medical journals, an article in 2016 by an international group of scientists concluded: “exaggerated claims about side-effect rates with statin therapy may be responsible for its underuse among individuals at increased risk of cardiovascular events. For, whereas the rare cases of myopathy and any muscle-related symptoms that are attributed to statin therapy generally resolve rapidly when treatment is stopped, the heart attacks or strokes that may occur if statin therapy is stopped unnecessarily can be devastating.”
New Since 2015-Novel lipid lowering medications
In July 2015, the FDA approved the first PCSK9 (protein monoclonal pro-protein convertase subtilisin/kexin type 9) Inhibitor injectable drugs for medical use. These are an incredible breakthrough. They offer a new option for patients who require further LDL reduction or those who have not tolerated statin therapy. PCSK9 inhibitors have been studied in thousands of patients and have been shown to be relatively safe. The potential side effects include injection site reactions (e.g. swelling or rash), elevation of liver enzyme blood test, neurocognitive events (>1%), limb pain and fatigue.
The First Step, Speaking to a Cardiologist
If you are experiencing any heart problems, or want to understand your risk for developing heart disease, it is time to see a cardiologist. A visit to the cardiologist can ensure you get the treatment you need and prevent larger problems from occurring.
Jonathan S. Katz, MD, FACC, is a Cardiologist at Crystal Run Healthcare and is seeing patients in the practice’s West Nyack and Suffern facilities.