Cholesterol and Statins

What you should know about cholesterol and statins

A friend of mine stopped by the office the other day.  She shared that she was concerned that her total cholesterol was ~ 210 and her doctor wanted to put her on a Statin. I have known this friend for many years and was disappointed that the Doctor who made this suggestion did not bother to ask her a few probing Health History questions.  My friend swims for one hour 4-5 times per week, and she had done so for many decades.  Needless to say, she is at a healthy weight and has a heathy blood pressure, which she has enjoyed her entire life.  Furthermore, her HDL level is an enviable 64, likely due to all that swimming.  May I remind you that HDL (aka High-Density Lipoprotein) is the good cholesterol.  It functions like a vacuum (think H for Hoover) removing LDL from the blood and transporting it to the liver where is can be reprocessed. I am very happy to see the tide shifting on what is considered a healthy cholesterol level but am disturbed by the blithe manner in which prescriptions for statins are still written.

I have no doubt that Michael Brown and Joseph Goldstein truly deserved to win that Nobel Prize for showing a correlation between plasma cholesterol and atherosclerosis.  I even wrote my dissertation on Cholesterol biosynthesis (and was tongue-tied during my thesis defense when a professor asked me if I thought that drinking red wine could lower cholesterol levels-a provocative concept in the early 90s).  Based on my own research I can tell you that statins are life-saving medicines for those who are genetically pre-disposed to high cholesterol levels.  This would include individuals who have heterozygous or homozygous mutations in the gene that codes for LDL-receptors.   These are cell surface proteins that remove LDL from the blood and target LDL for degradation. 

But there is a lot that we have yet to understand about the complete mechanism of statins.  They do indeed function to inhibit cholesterol biosynthesis, and to stimulate the synthesis of LDL receptors, but what exactly leads to the decrease in mortality?  Other agents that lower cholesterol through different mechanisms, such as Niacin or Zetia, do not show the same clinical outcomes.  It has been reported that statins have anti-inflammatory properties (Curr Pharm Des. 2012;18(11):1519-30) and so prevent heart disease. Good news for those who present with symptoms for Metabolic disease, but what about my friend who lacks even a single risk factor? 

In order for statins to do their magic they need to penetrate the liver where cholesterol synthesis takes place.  Among the many adverse side effects caused by statins, damage to the liver is one of the more concerning.  Other unpleasant side effects include muscle pain and weakness (myalgia), disturbed sleep and neurological deficiencies such as memory loss and confusion.  The chemical properties of statins are uniquely designed so that they do not penetrate the blood-brain-barrier.  That’s a good thing because your brain needs cholesterol to function properly.  However, I suspect that certain individuals lack this barrier function (leaky brain) and may exhibit memory loss as a result of reduced cholesterol levels in the brain.

If you are certain that you are not a candidate for atherosclerosis, owing to a healthy lifestyle, but are concerned about your plasma cholesterol levels, then add more fiber to your diet.  The average adult should be consuming 20-30 g of fiber per day.  Fiber has natural cholesterol lowering properties and is found in whole grains, fruits and vegetables.  My personal preference is to focus on fruits and vegetables as the 1000’s of phytonutrients found in this food group have many, wonderful anti-inflammatory properties. You might also want to increase consumption of fresh fish or take an Omega-3 fatty acid supplement.  Omega-3 fatty acids, which are NOT synthesized by the body like cholesterol, will improve the health of all of your cells, in the brain and heart in particular…with NO side effects.