QuestionMy internist discovered a bruie (sp?) in my carotid artery on the right side of my neck. I had an ultrasound and the results showed little blockage or at least no blockage that would require surgery. The internist increased my regimen of aspirin from 100 to 325 mg aspirin a day to prevent the bruie from becoming worse and help lower my cholesterol. He has not prescribed any statin drugs but because of the Bruie wants me to get my LDL cholesterol down to 100. My current cholesterol is 206 with a LDL of 137, HDL of 63 and Triglicerides of 36. I have a fairly intense daily exercise program. I am not overweight. I eat sensibly. I am 58 years old. Heart disease and high cholesterol does runs in my family. I am concerned I will not be able to get my LDL down to 100 with just increasing the aspirin dosage but would prefer not to start taking a manufactured statin drug. I am considering either Red Yeast Extract or Phytosterol, both natural substances. I know there is some evidence that the long term use of Red Yeast may have some impact on the liver and I already take Milk Thistle and CoQ10. What think thee?
AnswerMr. Hoyles,
Aspirin will not effect your cholesterol levels, but does effect the "stickiness" of the vessel interior as well as the ability of the blood to clot. Aspirin is one defense against getting a heart attack or stroke.
With your family history and the documentation of plaques in your carotid arteries, I agree with your internist and would suggest starting a statin drug vs. a "natural" substitute. In fact, even if you can get your LDL down, a low dose of a statin drug may be beneficial in preventing vascular disease. Here is why:
1. There is excellent data about statins improving both morbidity (read = quality of life) and mortality. They lower cholesterol, are VERY safe, and have been around for 20 years. Newer data coming out using statins to lower the LDL less than 70 has even shown REGRESSION of the plaques. That actually translates, in my opinion, to improving, not just simply delaying, the progression of vascular disease.
2. Statins also decrease the "inflammation" of the plaques, and therefore make it less likely to become sticky and form a clot. You may want to ask your internist about checking a CRP or C-reactive protein. This is a measure of inflammation. If it was elevated, it would push my decision further toward using a statin.
3. "Natural" alternatives (Red Rice Yeast, etc) may work to lower cholesterol, but there is no data for long term benefit (or side effects: remember hemlock is natural as well). There is also an issue with quality control between batches and companies. The Natural alternatives may in fact be fine and good, but I can't tell you for certain that they will impact on morbidity and mortality without well designed studies and longer times of study. They may indeed lower cholesterol, but what's more important is whether they prevent/alleviate disease. Most of the evidence is anecdotal at this point. What evidence is there that milk thistle, red rice yeast, and phytosterol are safe for long term use and won't cause you more trouble (liver disease, cancer, etc)? Scary part is that most people are taking these drugs (and yes they are drugs) based on the recommendations of store clerks. But I am editorializing...
Please don't misunderstand me, I am not against natural alternatives or supplements in general, but I AM against non-proven methods of treatment. CoEnzyme Q10 is a supplement that I would actually suggest along with a statin, since there is some good evidence that the combination is beneficial.
Sorry for the diatribe, you have struck a chord. I have many patients that ask similar questions and are concerned about the statins. My advice is to be critical and research all your choices AND your sources/experts (including me) and be (as you appear already) an educated consumer. As my mother has always said, not every author is an "authority".
If you were my family member, I would not hesitate to try a statin as first line therapy. My business is prevention and preservation of QUALITY OF LIFE, not just life. Once my patients have a stroke, there's unfortunately not much I can do except try and prevent a second. My goal is to try and help them prevent the first one. Obviously, smoking cessation, blood pressure and diabetes control, weight control, and exercise are important factors as well.
I hope that helps, and am glad you are researching your options.
