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In my opinion, pharmaceutical agents for
"cholesterol problems" (dyslipoproteinemia) should only be used when
diet, exercise, weight loss and stress reduction techniques
(meditation, yoga, Tai Chi) have proven ineffective in reducing
future cardiovascular risk. In a patient with
known coronary heart disease (CHD) and/or type 2 diabetes
(T2DM), I usually
recommend both drastic lifestyle changes as well as pharmaceutical
therapy from the onset. If the patient actually makes the necessary
lifestyle changes, the patient and I may later decide to taper off
some (or maybe more than just some) of the medications and this
typically will work out to some extent. On the other hand, if I have
a patient with high risk for later CHD and/or T2DM (but no actual
evidence of these disease states at present), I usually promote
appropriate lifestyle changes for around six months and only
consider adding medications if things don’t work out during that
time period. For people with lower risk of future CHD and/or T2DM, I
typically recommend necessary dietary and exercise modalities and
only add medications as a "last resort" after 12 months or
so.
Please remember that
lipid-modifying medications (regardless of which ones) only work in
the long run if they are added to an appropriate lifestyle. Such
medications aren’t like Jack’s magic beans – if you turn yourself
into the giant, they don’t work so well. Medications can work well as "supplements’" to
common sense; they usually work poorly as ‘"substitutes.’"
Imagine a stock pot full of water, boiling over. Taking any
lipid-modifying medication is like putting a lid on the pot. Losing
weight, eating right and exercising is like turning down the heat.
You turn down the heat as much as you can and, if the pot is still
boiling over, THEN you put on the lid. If you never turn down
the heat, heavier and heavier lids (more and more lipid-modifying
medications) will be required over time – only to delay the pot from
inevitably boiling over and making a big
mess.
Think of your body as a
kingdom, in which you wish to establish peace and harmony. Living
the proper lifestyle is like promoting goodness throughout the
kingdom while taking medications is like defeating evil. The more
you promote goodness; the less you will need to defeat evil.
However, if you must defeat evil on top of promoting goodness to
have peace and harmony (health) in the kingdom, so be it. Remember,
the medications are not your enemy – the CV disease process is. The
medications are your allies. You’d obviously rather win the war
against your enemy yourself (with diet and exercise) and not be
forced to call in the aid of allies (medications) since you are
proud. But you REFUSE to lose the war. The medications may be
bothersome (just like some allied foreign troops might be, for
example) but they are NOT the enemy (and "friendly fire" only
very rarely if ever occurs) – remember
that.
I
have always recognized that medications for HTN, T2DM and/or
dyslipoproteinemia are many times not even required if people "do
what they need to do" – become slender, live an active daily
lifestyle, eat proper amount of "healthy" food and limit their
intake of "junk" food. Even if medications do prove necessary, as
long as the individual follows this heart-healthy, common-sense
lifestyle, usually only low doses of limited numbers of medications
will be required. However, if the individual is overweight,
overstressed, sedentary, consumes excessive calories and/or limited
amounts of micronutrients, medications definitely will prove
necessary with more and more required as time passes, typically
following the law of diminishing return.
The medications used for
dyslipoproteinemia include Statins (Crestor, Lescol, Lipitor,
Mevacor, Pravachol, Zocor), cholesterol absorption inhibitors (CAI –
Zetia), combination Statin+CAI (Vytorin), bile acid sequestrants
(BAS – Questran, Welchol), prescription Niacin (Niaspan),
combination Statin+Niacin (Advicor), Fibrates (Lopid, Tricor),
Glitazones (Actos, Avandia) and prescription fish oils
(Omacor).
Call (239)
261-HAPI today for an appointment at the Heart Attack
Prevention Institute (HAPI) with Dr.
V. |
