The Statins: Lipitor, Crestor, Advicor, Pravachol, and Zocor: Coronary Disease Prevention and Reversal
Not being pedantic or pompous, please allow me to ask you a question. At what cholesterol level, or as an alternative, at what LDL (the bad cholesterol) level, does the atherosclerotic (hardening of the arteries) process start or stop in a population? Castelli, discussing the work of Nobel winners Brown and Goldstein, states that this value is 150 for total cholesterol.
Another question. What is the "set point" (in milligrams percent) cholesterol at which value atherosclerosis occurs in any given person that on the other side of which atherosclerosis begins to reverse? The answer to this question is an unknowable in any given individual. In the Dean Ornish group, that value was 180. However in the absence of knowing such information concretely for each individual patient, I feel it is our obligation to view the population as a whole consistently and to understand and adhere therapeutically to those numbers where we know coronary artery disease stops in all patients: 150 or less.
Since people with hardening of the arteries are already documented to be more susceptible, in the presence of documented coronary artery disease (or diabetes) a total cholesterol value of 130 or less is safer and is, in fact, what I believe epidemiology supports as the definition for "the natural human cholesterol." 90-130 is the cholesterol range of virtually all pre-mechanical societies and is the value where no coronary artery disease exists even in these vast populations.
I realize I have not discussed cholesterol fraction ratios, other risk factors, or how to achieve this value by medication, dosage, or diet. Mimicking this as a practice pattern, I guesstimate that there has been a 98% reduction of symptomatic coronary disease in my "old" patients. Said another way, of all the cardiac patients in my practice there is an average of only one invasive cardiac procedure a month. Many, truly most, of these patients had their "last" cardiac event 20 years ago or more. To achieve this, diet plus statins such as Lipitor, Crestor, Pravachol, Zocor, and lovastatin (especially with niacin = Advicor and/or along with Zetia when taken in their maximal doses result in:
- LVH (excess heart muscle thickness) regression (reversal)
- Reduced arrhythmias (irregular heartbeat) and inhibition of macular degeneration
- Reversed excess carotid (artery) wall thickness
- Reduced death, plasty, AMI and stroke (like a whole foods diet)
- Debatably reduced bone fractures
- Reduced protein in the urine (microalbuminuria)
- Reduced blood pressure and the frequency of diabetes
- Reduced Cardiac (hs) CRP (a very important predictor of heart damage and death), tumor necrosis factor, and MMP-9 (matrix metalloproteinase)
- Improved endothelial (the lining of blood vessels) function
- Inhibition monocyte adhesion to the endothelium/migration
Since statins reduce the body level of CoQ10, I recommend supplementing with 60-100 mg of a highly absorbable form of CoQ1O every day that you take a statin.
H. Robert Silverstein, MD