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Heart disease prevention: statins vs. diet

Heart disease is the leading killer in the U.S.; currently it is the cause for one in every six deaths, accounting for over 885,000 deaths and over $634.2 billion per year. The rise in heart disease is parallel to the rise of our westernized diets. More than 48% of the adult population in the U.S. has total and LDL cholesterol levels that are over healthy upper limits. LDL cholesterol is central to the development of heart disease, and about 60% of heart disease is related to the total blood cholesterol levels. For every 1.0mmol/l that LDL cholesterol is decreased, there is an apparent 22% reduction in heart disease risk. As a result statins, a medication that lowers LDL cholesterol, is the most widely used drug world-wide. Do you have high cholesterol or blood pressure? Are you considering or taking statins? This article will shed light on dietary and pharmacological heart disease interventions.

Statins are unquestionably effective at lowering LDL cholesterol, but at what cost? Firstly, statins lead to an interfered insulin secretion and ultimately decreased glucose tolerance; they are associated with an increased risk for diabetes. They also lead to a reduced coenzyme Q10 (a vital fat soluble antioxidant) content, which is important for mitochondrial respiration. A deficiency may lead to a number of brain and muscle related syndromes. Just this past year, on February 28th, 2012, the FDA updated the requirements for labeling statins. In addition to recommendation adjustments, labels must now include monitored liver function, diabetes risk or worsened glucose control, and memory loss reports.

Now I don’t want to take away from the fact that statins are a really effective way to reduce your risks for heart disease. I do however want to get it across that statins are typically overprescribed without patients receiving enough information about their diets. Take the easy fix instead of making suitable adjustments that will allow a lowered risk for not only heart disease, but just about any chronic disease out there? Why are doctors not taking the time to address diets; especially when overwhelming research indicates that dietary measures can significantly reduce LDL cholesterol? Why are statins starting to be the first line of treatment, sometimes in even lower risk individuals?

walnuts davidlat sxcSo what is the research saying about diets on heart disease interventions? There’s significant evidence that varying food components including plant stanols and sterols, soy protein, beta-glucans, and nuts can dramatically reduce LDL cholesterol. These dietary substances have the most evidence for their effectiveness compared to other food items. Individually they can make a 3–9% LDL cholesterol reduction, but their effects are much greater when combined. In clinical trials where all of the above foods were used (a portfolio diet), LDL cholesterol was reduced by over 30% in well controlled clinical studies and 15% in uncontrolled community-based studies. While compliance may be challenging (seen by the reduced effects in community studies), the portfolio diet really indicates the strength of a plant based diet.

Currently there’s growing evidence of dark chocolate, green tea, flaxseed, and garlic potentially lowering LDL cholesterol. Cardio exercise interventions (even without other dietary interventions or significant weight loss) are shown to improve LDL cholesterol. Lastly, LDL cholesterol typically rises in proportion to dietary short-chain fatty acids; a reduction would lead to LDL cholesterol improvements. So what does all of this mean? A plant-based diet, along with healthy activity levels, is a strong method for reduced LDL cholesterol.

Vegetarian and vegan diets consistently show a reduced risk for heart disease; these diets result in significantly lower blood lipid concentrations, fewer age related increases in blood lipids, and reduced total and LDL cholesterol. In randomized controlled trials, ovo-lacto vegetarians (vegetarians who eat eggs and dairy) had a reduction of about 5–10% of total and LDL cholesterol while vegan diet interventions had a reduction of about 15–25%. When these diets were combined with additional fiber, soy, and nuts, 20–35% reductions were evident. Plant-based diets are associated with lower weight, body mass index, LDL cholesterol, blood pressure, and inflammatory markers as well as an improved insulin sensitivity and glycemic control. Clearly there is a growing amount of intervention trials showing success using a plant-based diet to reduce LDL cholesterol.

chocolate premekv sxcHow can you apply this information in order to reduce your risks for heart disease? Eat the rainbow in terms of vegetables and fruits, eat lots of nuts, and reduce the amount of high-glycemic index foods (tables are found easily online). Reduce your meat and refined food (e.g. things that aren’t refrigerated or have unpronounceable chemical ingredients) consumption and try to up your exercise a bit. The exercise increase doesn’t have to be dramatic, but you do need to get moving! Maybe take a half hour walk or find a fun, new activity. Lastly, consider an omega-3 supplement (with DHA); omega-3 is an important fat that significantly reduces risks for heart disease. Vegans and vegetarians should also strongly consider a DHA omega-3 supplement because it is virtually non-existent in their diets.

Elevated blood lipids typically results in significant financial costs and health risks. As a result, dietary changes should be the first-line therapy because they are both safe and cost effective. While non-vegetarian diet interventions have been only found to be modestly effective, making 5–10% LDL and total cholesterol reductions; plant-based diets have been consistently shown to have much greater results. Are you on statins or considering taking them? Do you have elevated LDL-cholesterol? Before turning to statins, talk to your doctor about trying a plant-based diet!

Deichmann R, Lavie C, Andrews S. (2010) Coenzyme q10 and statin-induced mitochondrial dysfunction. Ochsner J.;10(1):16-21.

Ferdowsian H, Barnard N. (2009) Effects of Plant-Based Diets on Plasma Lipids. doi:10.1016/j.amjcard.2009.05.032.

Goff LM, Cowland DE, Hooper L, Frost GS. (2012) Low glycaemic index diets and blood lipids: A systematic review and meta-analysis of randomised controlled trials. doi:10.1016/j.numecd.2012.06.002.

Harland J. (2012) Food combinations for cholesterol lowering. doi:10.1017/S0954422412000170.

Khardori R, Nguyen D. (2012) Glucose control and cardiovascular outcomes: reorienting approach. doi:10.3389/fendo.2012.00110.

Lewis S. (2011) Lipid-lowering therapy: who can benefit? doi:10.2147/VHRM.S23113.

McEvoy C, Temple N, Woodside J. (2012) Vegetarian diets, low-meat diets and health: a review. doi:10.1017/S1368980012000936.

See this and other articles on Jennifer Novakovich's website

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