Cholesterol Archive

Q. I am taking pravastatin for high cholesterol, but my numbers are still high. Should I try red yeast rice?

A. Red yeast rice, a fermented species of yeast called Monascus purpureus, has been used in traditional Chinese medicine for centuries. It contains a number of compounds called monacolins. Like the cholesterol-lowering statin drugs, monacolins hamper the production of cholesterol by inhibiting the enzyme HMG-CoA reductase, which makes LDL ("bad") cholesterol. One of the monacolins in red yeast rice extract is the active ingredient in lovastatin. In studies of people with high cholesterol, red yeast rice extract taken for two to three months lowers total and LDL cholesterol and triglycerides.

About one in every five people who take a cholesterol-lowering statin drug experiences a side effect, most often muscle weakness or muscle pain. In about half of these people, the discomfort causes them to discontinue using the drug. An analysis of 134,263 adults prescribed statins at two Harvard-affiliated hospitals, Brigham and Women's and Massachusetts General, found that 18,778 experienced a statin-related problem that caused 11,124 to stop taking the drug. More than half of those who stopped resumed taking a statin within 12 months—40% went back to the same statin and 60% switched to a different one—and 90% of those who restarted statin treatment were still taking the medication one year later.

Because statins are highly effective in preventing deaths from cardiovascular disease, it is particularly important for people with diabetes, kidney disease, and known cardiovascular disease to take a statin for life. When statins cause side effects—muscle pain, for example—the study shows that statin therapy may be temporarily stopped and then resumed. For most people, this won't be a problem; others may find that switching to a different statin is the best way to lessen or avoid troublesome side effects.

Cardiac disease is strongly associated with a type of cognitive impairment.

You know that preventing heart disease is also key to preventing stroke. But did you know heart health is also key to thinking health? "An increasing proportion of what used to be called ‘senile' dementia is turning out to be vascular dementia," says cardiologist Dr. Deepak Bhatt, a professor at Harvard Medical School.

The FDA ensures that generic medications are just as effective as brand-name versions. Now it's been confirmed in a study of generic atorvastatin (Lipitor).

Researchers tracked changes in cholesterol in 85 people before and after they switched from brand-name
Lipitor to the generic equivalent. On average, their "bad" LDL increased just 0.3% after the switch—an insignificant change that would have no effect on the participants' health.

Q. Recently, my insurance company switched my cholesterol medication from Lipitor to generic atorvastatin. Are generic medications as good as brand-name drugs?

A. You can take your generic medications with the same confidence that you take the brand-name versions. The FDA requires that a generic medication contain the same active ingredient as its brand-name counterpart. It must contain the same amount of medication and be equally absorbed by the body.

It appears that eating one egg a day is not associated with an increased risk of heart disease or stroke. Although eggs are high in cholesterol, researchers say the effects of dietary cholesterol on blood cholesterol levels are small.

Kidney function declines with age in some people. A heart-healthy diet and lifestyle will protect your kidneys. Once kidney function reaches a certain low level, medication and other steps to protect the kidneys may be necessary.

Q. I am taking simvastatin for high cholesterol. Should I take coenzyme Q10 to prevent muscle pain?

A. There is no convincing medical evidence to suggest that coenzyme Q10 (CoQ10) prevents muscle pain in people taking statins. But because the risk of side effects from CoQ10 is low, many doctors would recommend a one-to-two month trial of the supplement (doses range from 100 to 200 mg daily) to help with statin-related muscle cramps, pain, or weakness. Make sure your doctor knows you are taking it.

Eliminating four risk factors can reduce PAD cases.

When it comes to peripheral artery disease (PAD) among men, common risk factors have a strong cumulative effect. That's among the findings of a recent Harvard study published in The Journal of the American Medical Association. "The more risk factors one accumulates, the higher the risk, and the severity of risk factors increases risk," says author Dr. Ken Mukamal, associate professor of medicine at Harvard Medical School.

PAD and its risks

PAD is caused by plaque buildup in the walls of the arteries in your limbs, especially your legs. These clogged arteries put you at risk for ulcers and even gangrene. In addition, people with PAD are at an increased risk for heart attack or stroke.

High doses of the statin drug atorvastatin (Lipitor) cause muscle pain in a small number of healthy people, but are not associated with muscle weakness, according to a study in Circulation.

Many people take statins to lower "bad" LDL cholesterol. Studies suggest that 10% to 15% of people on statins develop muscle-related symptoms, including pain, cramps, and weakness. But so many people take statins that some of the reported muscle complaints may be just coincidence.