health right now

FROM THE HEART DOC

health right now

Heart Savers
The lowdown on statins and their role, especially for diabetics
DR VIKAS SAINI is a
clinical cardiologist and researcher at Harvard Medical School and Harvard School of Public Health. He is president of the Lown Cardiovascular Research Foundation in Boston. Write to him at vikas.s@preventionindia. com.

tatins are one of the more powerful classes of medication for cardiovascular prevention. These drugs lower the bad cholesterol (LDL), sometimes very dramatically. The critical element to know in those who have not had any heart trouble as yet, is whether the overall risk of developing heart disease is low or high. The higher the risk, the greater the benefit.

understood. For instance, it appears that much of the heart risk comes from something other than the cholesterol profile itself. It may be that the elevated insulin levels from the insulin resistant state of most type 2 diabetics are harmful. There are many likely biological pathways that lead to trouble.

Why diabetics should be on statins

Diabetics and pre-diabetics typically have a pattern of lipids showing elevated triglycerides and decreased HDL (good) cholesterol levels. Nevertheless, reduction of the LDL cholesterol with statins leads to reductions in the incidence of heart disease, other vascular events like strokes and overall mortality. For diabetics, even modest elevations of LDL cholesterol are equivalent in risk to a much higher LDL cholesterol in non-diabetics.
TOP: PHOTOGRAPH BY: RITESH SHARMA; BOTTOM: SHUTTERSTOCK/INDIAPICTURE

How diabetes affects the heart

One of the major risk factors for heart disease is diabetes. This is especially crucial with regard to India, where rates of diabetes are skyrocketing. In this group of people, even when there is no known heart disease, statins should strongly be considered as part of a programme of prevention. The way that diabetes influences the cardiovascular system is not fully

In recent years, it has become clear that statins can paradoxically increase the risk of developing diabetes, but only slightly. This is not a serious reason to avoid statin therapy, since the effect is so small, and far outweighed by the prevention benefits. In one study researchers calculated that it would require the treatment of 255 patients with statins for four years to result in one extra case of diabetes. Meanwhile, over five deaths and many strokes and surgeries would havebeen prevented. Thus, while the effect seems to be real and related to higher doses of statins, it is nevertheless not enough to change clinical practice. Several additional points should be made. Firstly, the definition of diabetes in these studies was a new elevation in blood glucose levels. We dont know for sure whether these patients are really diabetic in the same way as those who have become diabetics without being on statins. It might be different. For instance, these statin-induced diabetics

seem to have the same lowered risk of heart attacks as others on statins who did not develop diabetes. So it may be a case of a worsened glucose but cardiac protection. A second point that emerges from this story is that practising a healthy lifestyle with a good diet and plenty of exercise to prevent the onset of diabetes is always wise, even when taking preventive medications. In other words: doing all the right things can only increase the benefits to health.

Statins Rx

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FEBRUARY 2012 PREVENTION

FEBRUARY 2012 PREVENTION