Hypercholesterolaemia is a condition characterised by an excess of cholesterol in the blood. An alternative term is dyslipidaemia, which encompasses elevated triglycerides, low levels of HDL-C, and high LDL-C (1).
Hypercholesterolaemia is an important risk factor for cardiovascular disease, coronary heart disease and arterial disease and is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States (2).
A first line option for doctors is to prescribe a statin. Statins are a class of drugs that help lower cholesterol levels in the blood. Many statins exist e.g.
- Atorvastatin (Lipitor)
- Rosuvastatin (Crestor)
- Simvastatin (Zocor)
- Fluvastatin (Lescol XL)
I’m focussing on one of the most commonly prescribed statins here: Atorvastatin, which is sold under the brand name Lipitor.
- It comes in 4 strengths: 10/20/40/80 mgs
- Usually a patient is started on 10 mgs daily which can be changed every 4 weeks to a max of 80 mgs according to response and tolerability.
- You may take it with or without food.
How does Atorvastatin/Lipitor work?
The most common side effects can be grouped under the below headings:
- Common colds, allergic reactions
- Statins may raise blood glucose levels as a result of decreasing insulin sensitivity in cells (3) and in patients at high risk of future diabetes, may lead to hyperglycaemia
- Headaches, pain in the pharynx or larynx
- Gastrointestinal disorders – constipation, wind, nausea, diarrhoea
- Statins are also known to effect nitric oxide levels through up regulation of nitric oxide synthase. There is some evidence to imply that nitric oxide acts on inhibitory nerves in the colon that can impair motility (4)
- Myalgia, arthralgia, joint swelling, back pain
- While the aetiology here is not fully understood, one theory is that statins decrease the levels of coenzyme Q10 which is essential for mitochondrial energy production, especially in muscle tissue (5)
- Abnormal liver function
There are many drug nutrient interactions but one worth paying particular notice of is coenzymeQ10 (CoQ10).
Atorvastatin inhibits production of mevalonate, a precursor to both cholesterol and CoQ10 (6).
In one study atorvastatin decreased plasma CoQ10 levels and supplementation with CoQ10 increased their levels (7). Therefore, many doctors recommend CoQ10 supplementation to prevent the drug-induced decline in CoQ10 levels.
CoQ10 is involved in energy production in the mitochondria and a reduction in CoQ10 concentrations may promote the myopathies (muscle diseases, pains, cramps, joint swelling, back pain) that have been associated with statin treatment as a result of mitochondrial damage (6).
This is especially relevant for the myocardial muscle that pumps the heart.
What you can do
Take some simple steps to mind your heart;
- avoid too much saturated fats and cholesterol heavy foods (animal products)
- avoid processed/refined foods
- instead focus on wholefoods = foods in the their natural state like unprocessed fruits, vegetables and wholegrains, nuts and seeds
- eat some fish once or twice a week
- take regular exercise
- mind your stress levels and develop some tactics for dealing with stress – sport, prayer, mindfulness, just saying no, not caring as much anymore! whatever works for you to manage your stress levels DOWN
- avoid alcohol, which increases triglyceride levels
- avoid grapefruits, as they can interfere with the drugs efficacy
Yours in health and happiness,