My Doctor Wants Me on a Statin: What Should I Know First?

My Doctor Wants Me on a Statin: What Should I Know First?

If your doctor tells you you need to take a statin to lower your cholesterol, you're not alone. Millions of people are prescribed statins every year to help reduce the risk of heart disease, stroke, and other cardiovascular problems. But before you head to the pharmacy, it's worth understanding the potential long-term health consequences of taking statins and why it might be helpful to take a deeper look into your heart health before jumping on the medication route.

Statins are often prescribed to lower LDL ("bad") cholesterol, which has been linked to heart disease. However, recent research and holistic approaches to cardiovascular health have revealed that cholesterol levels alone don't paint the full picture of your heart health. In fact, lowering cholesterol with statins may be necessary for some, but they often ignore the underlying root causes of cardiovascular issues and may even have long-term side effects that may compromise your overall health.

This article will explore the potential downsides of statins, how to understand your heart health more deeply, and which alternative tests and methods can give you a more comprehensive view of your cardiovascular risk. We'll also discuss the importance of working with healthcare providers, such as carnivore or keto-friendly cardiologists, who can help you navigate these options.

The Hidden Risks of Statins

Statins work by blocking an enzyme in the liver that’s responsible for making cholesterol. While lowering LDL cholesterol may seem beneficial, statins don’t come without risks. Here are some long-term health consequences associated with statin use:

1. Muscle Pain and Weakness

One of the most common side effects of statins is muscle pain or weakness, a condition known as myopathy. Statins can interfere with coenzyme Q10 (CoQ10) production, a compound that helps your muscles produce energy. Over time, low CoQ10 levels can lead to chronic muscle pain, weakness, and fatigue.[1]

2. Increased Risk of Type 2 Diabetes

Statin use has been associated with an increased risk of developing type 2 diabetes. Research suggests that statins can interfere with insulin sensitivity and glucose metabolism, raising blood sugar levels and potentially pushing some people into the diabetic range.[2]

3. Cognitive Decline

Some patients report experiencing memory problems and cognitive decline after starting statins. While this side effect is not as common, it’s been suggested that lowering cholesterol too much can interfere with the brain’s ability to function properly, as cholesterol plays a crucial role in brain cell communication.[3]

4. Liver Damage

Statins can put a strain on the liver, potentially leading to liver damage over time. Doctors often monitor liver enzyme levels in patients taking statins, but even mild liver damage can affect your overall metabolic health.[4]

5. Nutrient Depletion

Statins can interfere with absorbing essential nutrients like CoQ10 and vitamin K2,[5],[6], critical for cardiovascular health. Low CoQ10 can exacerbate muscle issues, while a deficiency in vitamin K2 may increase the risk of arterial calcification and worsen heart health.

Given these risks, it’s important to consider the root causes of your cardiovascular risk factors and explore a more comprehensive approach to heart health.

Looking Beyond Statins: A Root-Cause Approach to Cardiac Health

Cholesterol is an essential substance that is vital in maintaining overall health and bodily functions. Despite its negative reputation, cholesterol is crucial for the body’s cellular structure and hormone production. It is also involved in many key processes that support our well-being. A few being:[7]

• Cell membrane integrity: Cholesterol helps maintain the structure and fluidity of cell membranes.
• Hormone production: It's essential for producing hormones like estrogen, testosterone, and cortisol.
• Vitamin D synthesis: Cholesterol aids in producing vitamin D when the skin is exposed to sunlight.
• Bile production: It assists in forming bile acids necessary for digesting and absorbing fats.

Heart disease is a complex condition influenced by multiple factors, including inflammation, insulin resistance, and metabolic health. Rather than focusing solely on lowering cholesterol (aka blaming the firefighter for the fire), it’s crucial to investigate the underlying causes that may contribute to heart disease.

1. Inflammation and Heart Disease

Inflammation plays a key role in the development of heart disease, often contributing to plaque buildup in the arteries. One way to assess inflammation in the body is through a C-reactive protein (CRP) test. CRP is a marker of systemic inflammation, and elevated levels are associated with an increased risk of cardiovascular events.[8]

C-reactive protein (CRP) levels are measured in milligrams per liter (mg/L) of blood. Here is a general guideline for interpreting CRP levels:

• Low CRP: Less than 1 mg/L — Indicates a low risk of inflammation and cardiovascular disease.
• Moderate CRP: 1 to 3 mg/L — Suggests a moderate level of inflammation, which could be linked to an increased risk of heart disease.
• High CRP: Greater than 3 mg/L — Indicates significant inflammation, suggesting a higher risk of cardiovascular issues or other inflammatory conditions.

Extremely high CRP levels (greater than 10 mg/L) may indicate acute inflammation from infection or another significant health issue, and further medical evaluation is often required.

Lowering inflammation should be a top priority if your CRP levels are high. Several strategies can help:

• Cold plunges: Cold exposure can reduce inflammation and improve vascular health.
• Fasting: Intermittent fasting has been shown to lower inflammation, improve insulin sensitivity, and promote heart health.
• Sauna: Regular sauna use can increase circulation, promote detoxification, and reduce chronic inflammation.
• Exercise: Regular physical activity can help lower inflammation, improve cardiovascular health, and boost overall well-being.
• Stress Management: Mindfulness, meditation, and relaxation techniques can reduce stress, which lowers inflammation and supports heart health.
• Sleep: Prioritizing quality sleep is essential for reducing inflammation, supporting recovery, and maintaining overall metabolic health.

2. Lipoprotein(a) and Lipoprotein(b)

While traditional lipid panels only measure LDL and HDL cholesterol, they don’t provide the full picture of your cardiovascular risk. Testing for Lipoprotein(a), or Lp(a), can offer additional insights. Elevated Lp(a) levels are a genetic risk factor for heart disease and are often overlooked in standard cholesterol testing.[9]

Similarly, Lipoprotein(b), or Lp(b), is another type of cholesterol particle that can increase the risk of cardiovascular events. High Lp(b) levels may indicate the presence of small, dense LDL particles, which are more likely to contribute to arterial plaque buildup than larger, fluffier LDL particles.[10]

3. HDL to Triglyceride Ratio

The ratio of HDL cholesterol to triglycerides is another important marker of heart health. A low HDL-to-triglyceride ratio can indicate poor metabolic health and insulin resistance, increasing the risk of heart disease.[11]

Why the HDL to Triglyceride Ratio Matters

A low HDL-to-triglyceride ratio can be a sign of insulin resistance, a condition in which your body’s cells don’t respond well to insulin, leading to higher blood sugar levels. Insulin resistance is a precursor to metabolic syndrome, which increases the risk for heart disease, stroke, and type 2 diabetes.

When triglycerides are elevated and HDL is low, it often indicates poor lipid metabolism, inflammation, and potentially the presence of small, dense LDL particles. These small LDL particles are more prone to causing plaque buildup in the arteries, increasing the risk of atherosclerosis and cardiovascular events. Conversely, a higher HDL-to-triglyceride ratio is associated with better heart health, reduced inflammation, and improved lipid metabolism.[11]

Ideal HDL-to-Triglyceride Ratio

An ideal HDL-to-triglyceride ratio is 1:2 or lower, meaning your triglyceride levels should not exceed twice your HDL levels. Some experts suggest that an HDL-to-triglyceride ratio of 1:1 or lower is optimal for metabolic and cardiovascular health.

Example of a Good Ratio

Let’s say your lipid panel results show the following:

• HDL cholesterol: 60 mg/dL
• Triglycerides: 80 mg/dL

In this case, the ratio is about 1.33, considered healthy and suggests good metabolic health. A ratio below 2 is ideal, and lower ratios are often associated with a reduced risk of cardiovascular disease.

What If Your Ratio Is High?

A high HDL-to-triglyceride ratio, such as 3 or more, may indicate insulin resistance or metabolic dysfunction.[12] In such cases, addressing lifestyle factors like diet, physical activity, and stress management can help lower triglycerides, raise HDL, and improve overall heart health. A low-carb or ketogenic diet, intermittent fasting, and regular exercise are some of the strategies often recommended for improving this ratio.

Monitoring this ratio is important because it provides insight beyond just the individual cholesterol numbers, giving a better understanding of overall metabolic and cardiovascular health.

4. LDL Particle Size and Number

Traditional LDL measurements don’t tell you the size of your LDL particles, which can be important in determining your heart disease risk. Small, dense LDL particles are more likely to cause plaque formation in the arteries, while larger, buoyant LDL particles are less harmful. Requesting an LDL particle size and number test can provide a more detailed look at your cholesterol levels and cardiovascular risk. So, there is less concern if you have high LDL, but most are larger particle sizes.[13] 

5. Metabolic Health and Insulin Resistance

Metabolic health plays a huge role in cardiovascular disease. Insulin resistance, which occurs when the body doesn’t respond properly to insulin, is a major driver of heart disease. Testing for fasting insulin and glucose levels can help you and your doctor understand how your metabolic health affects your heart.[14] 

6. Coronary Artery Calcium (CAC) Score

A coronary artery calcium (CAC) score is one of the most accurate ways to assess the presence of plaque in your arteries. This non-invasive test uses a CT scan to measure the amount of calcified plaque in your coronary arteries. A high CAC score indicates a higher risk of heart attack, while a low score suggests that you have little to no plaque buildup.[15]

CAC scores can help you and your doctor make more informed decisions about your treatment options, particularly if you’re considering a statin.

Better Testing: Cardiac IQ 

While standard cholesterol tests provide limited information, there are more advanced tests that can offer a clearer picture of your heart health. One such test is Quest’s Cardiac IQ test, which includes a comprehensive panel of markers, including:

• LDL particle size
• Lipoprotein(a)
• Lipoprotein(b)
• CRP levels
• HDL:Triglyceride ratio

This advanced testing allows you and your doctor to assess your overall cardiovascular risk beyond cholesterol levels. While some of these tests may not be covered by insurance, they are often available through direct-to-consumer labs, allowing you to pay out of pocket and order them yourself. Although it may require an extra investment, having this detailed information equips you with the knowledge needed to make better decisions about your heart health.[16]

Reducing Inflammation and Improving Heart Health Naturally

Once you have a fuller picture of your heart health, addressing any underlying issues, such as inflammation and insulin resistance, is important. Here are some natural ways to improve heart health:

1. Adopt a carnivore (or keto) lifestyle

Carnivore focuses on consuming only animal-based foods such as meat, fish, eggs, and animal fats, which can significantly improve metabolic health, lower triglycerides, and reduce inflammation. By eliminating carbohydrates, the body burns fat for fuel, improving insulin sensitivity and stabilizing blood sugar levels, which helps combat insulin resistance. This approach also lowers triglycerides by reducing the body's reliance on glucose while increasing HDL cholesterol and promoting larger, less harmful LDL particles, supporting cardiovascular health. Additionally, the carnivore lifestyle reduces inflammation by cutting out pro-inflammatory foods like refined carbs and seed oils, making it a powerful strategy for enhancing heart and metabolic health.[17]

2. Intermittent Fasting

Fasting has been shown to reduce inflammation, improve insulin sensitivity, and promote heart health. By giving your body a break from constant digestion, intermittent fasting allows your cells to repair and rejuvenate, improving cardiovascular function.[18]

3. Exercise and Movement

Regular exercise is one of the most effective ways to improve cardiovascular health. Combining strength training and cardiovascular exercise can help reduce blood pressure, improve circulation, and lower inflammation.[19]

4. Cold Exposure and Sauna Therapy

As mentioned above, cold plunges and sauna therapy can help reduce systemic inflammation and improve heart health. Cold exposure triggers the release of anti-inflammatory proteins, while sauna use improves circulation and detoxification.[20],[21]

Working with a Carnivore or Keto-Friendly Cardiologist

If you’re interested in taking a more holistic, root-cause approach to your heart health, it’s essential to work with a healthcare provider who understands the nuances of metabolic health and diet. Many traditional cardiologists focus solely on lowering cholesterol, but a keto- or carnivore-friendly cardiologist will consider other factors, such as inflammation, insulin resistance, and metabolic health.

One excellent resource is Dr. Philip Ovadia, a heart surgeon and metabolic health expert. In his book, Stay off My Operating Table: A Heart Surgeon’s Metabolic Health Guide to Lose Weight, Prevent Disease, and Feel Your Best Every Day, Dr. Ovadia emphasizes the importance of metabolic health in preventing heart disease and offers practical advice on how to improve your heart health without relying on medications like statins. Dr. Ovadia also has a YouTube channel where he shares valuable insights into heart health and the metabolic approach to preventing heart disease.

Conclusion: Be Your Own Advocate

When your doctor suggests starting a statin, taking a step back and considering all your options is essential. Sometimes, that means having to order your own testing. While statins may be necessary in some cases, they often come with significant side effects and don’t address the root causes of heart disease.

By exploring advanced testing options, such as Quest’s Cardiac IQ panel, and addressing inflammation, insulin resistance, and metabolic health, you can take a more comprehensive approach to your heart health. Working with a healthcare provider who understands these nuances, such as a keto- or carnivore-friendly cardiologist, can help you make informed decisions about your treatment plan.

Ultimately, the goal is to naturally reduce cardiovascular risk, avoid unnecessary medications, and improve long-term health.

The information provided in this blog is for educational and informational purposes only and is not intended as medical advice. It is important to consult with a qualified healthcare professional or your physician before making any changes to your diet, lifestyle, or healthcare regimen, especially if you have underlying medical conditions or are taking medications. The content here is based on research and personal experiences, but individual health needs vary. Always seek the guidance of a healthcare provider for advice tailored to your unique health circumstances.

Citations:

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