“We can decrease the risk of that patient having another problem with the heart.”
Having high cholesterol, or hyperlipidemia, isn’t a disease in itself: It’s a risk factor for other serious diseases (such as heart disease) and cardiovascular problems (such as a heart attack). That’s because excess cholesterol deposits on artery walls and forms hard plaque, which narrows the arteries.
There are many lifestyle changes that can lower cholesterol naturally, but if someone is at a high risk of a heart attack or stroke, or lifestyle changes don’t lower cholesterol enough, their doctor may prescribe medications to lower cholesterol, such as statins.
“Statins as a class are so beneficial for lowering cardiovascular risk,” says Michelle W. Bloom, MD, cardio-oncologist at Stony Brook Medical Center. These medications lower cholesterol by reducing the amount produced by the liver.
“There is very clearly a role for using statins, both in the realm of primary prevention, as well as in the realm of secondary prevention,” says Dr. Bloom.
Primary Prevention of Cardiovascular Disease
“Primary prevention means preventing something from occurring for the first time,” says Dr. Bloom. In this case, it means preventing someone from developing heart disease, heart failure, or atrial fibrillation.
Doctors may prescribe statins as primary prevention for a patient with many risk factors for these heart diseases, such as:
Having high cholesterol
Having high blood pressure
Being over age 40
Or being physically inactive.
“In patients that have a high risk of developing a problem with the heart, such as a heart attack [or] a stroke, statins decrease an individual patient’s risk by lowering inflammation and by lowering cholesterol levels,” says Dr. Bloom.
Secondary Prevention of Cardiovascular Disease
“Secondary prevention is the prevention that we use for a second or a third or a subsequent event,” says Dr. Bloom. “We know that there’s a very clear role in using statins for patients who have already had a heart attack, already had a stroke, already developed heart failure from blockages in the arteries and a weakening of the heart.”
In other words, it’s not too late to get the benefits from statins once you’ve already been diagnosed with a heart problem: They play a role in both treatment and prevention. “We can decrease the risk of that patient developing another problem with the heart,” says Dr. Bloom.
While statins and other medications can make a big difference in an individual’s risk factor profile, lifestyle changes for a healthy heart are still recommended. Medications can only do so much to improve your overall health.
“We can give a patient any medication in the world, but if a person isn’t empowered to change their lifestyle, then we’re not doing the best we can for that individual patient to decrease the risk of a cardiovascular event,” says Dr. Bloom.
Dr. Bloom is an associate professor of medicine at Stony Brook University Medical Center, a fellow of the American College of Cardiology, and a fellow of the Heart Failure Society of America.
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We think of statins as working in many different ways.
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Statins as a class are so beneficial for lowering cardiovascular risk.
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There is very clearly a role for using statins,
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both in the realm of primary prevention,
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as well as in the realm of secondary prevention.
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Primary prevention means preventing something
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from occurring for the first time.
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For example, preventing a person from developing heart failure,
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preventing a person from developing coronary artery disease.
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We know that there is a very clear role for using statins
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in a primary prevention setting.
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In patients that have a high risk of developing a problem with the heart,
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such as a heart attack, such as a stroke,
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statins decrease an individual patient's risk
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by lowering inflammation and by lowering cholesterol levels.
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Patients that are at higher risk that would benefit
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from a primary prevention approach, patients who are smokers,
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older age patients, patients with diabetes,
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patients that have high blood pressure,
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things that increase your cardiovascular risk.
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Secondary prevention is the prevention that we use
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for a second or a third or a subsequent event.
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We know that there's a very clear role in using statins
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for patients who have already had a heart attack,
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already had a stroke, already developed heart failure
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from blockages in the arteries and a weakening of the heart.
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Those are patients that very clearly benefit from high-dose statins
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because we can decrease the risk of that patient
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developing another problem with the heart.
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I cannot say enough times to patients how critically important it is
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to maintain an ideal body weight, and if you're overweight,
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to lose weight, to exercise at least a little bit every day,
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get the juices flowing, go outside, take a 20-minute walk,
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don't eat things that are high in sugar or high in fat.
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We can give a patient any medication in the world,
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but if a person isn't empowered to change their lifestyle,
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then we're not doing the best we can for that individual patient
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to decrease the risk of a cardiovascular event.
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Cholesterol medications. Dallas, TX: American Heart Association. (Accessed on January 9, 2020 at https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia/cholesterol-medications.)
Control your cholesterol. Dallas, TX: American Heart Association. (Accessed on January 9, 2020 at https://www.heart.org/en/health-topics/cholesterol/about-cholesterol.)
Top things to know: 2019 CVD primary prevention guideline. Dallas, TX: American Heart Association. (Accessed on January 13, 2020 at https://professional.heart.org/professional/ScienceNews/UCM_503728_Top-Ten-2019-CVD-Primary-Prevention-Guideline.jsp.)