Cholesterol Management and The Statin Survey
22
August

By Adem Lewis / in , , , , , , , , , , , , , , , , /


Welcome to the program. I’m your host Neal Howard here on Health Professional Radio. So glad that you could tune in with us today. Our guest is Dr. Eliot Brinton, President of the Utah Lipid Center and fellow of the American Heart Association also National Lipid Association and he’s joining us here on the program today to talk about cholesterol, to talk about best practices for managing your cholesterol, also were gonna discuss some of the results of a recent survey that was taken the ‘Statin Survey’ conducted by Harris Poll. Welcome to Health Professional Radio Dr. Eliot Brinton. Great to be with you. Give our listeners a bit of background about yourself before we get right into the topic. I am trained in endocrinology but my primary focus has always been lipids. And so I’m a lipidologist and I care passionately about treatment of high cholesterol and that’s our focus for today. How many folks here in the United States are suffering with high cholesterol? Well, it’s about a hundred million adults or about 2 out of 5, a lot of people. A whole lot of folks. Now, let’s talk a bit about the effect that high cholesterol has on the body and first of all, why it’s so important to manage it in the first place? Well, a high cholesterol is really the number one treatable factor and with regard to cardiovascular disease which is in turn the number one cause of death and disability in the U.S. So very, very big deal. Now, why is it that cholesterol is still such a problem when there’s so much information out there about low cholesterol diets? Well, the first point here is that even though there’s some information out there, we don’t do very well to following that information. We have a lot of pressure, some of it is internal, our own taste buds and some of its external, social and just availability of food. So we are not very good at eating the way that we know it should, that is one issue. The other issue that’s really I think important to keep in mind is that even though diet is always our first step and really the cornerstone of treatment, the effective diet on cholesterol levels is relatively limited compared to what effect there is from genetic factors and then what benefit can be had by appropriate medication. So we’re talking reversal of these effects or simply management? Well, that’s a great question. We’re certainly going to reverse the lipid disorder. The question is what happens at the level of the artery wall? And on the one hand, this is controversial and we don’t know as much as we’d like to know. But the most important issue here is disease incidence. So we know that we can reduce the risk of a future heart attack or stroke whether the patient has had one in the past or not. And that’s the most important issue. So yes, we do debate this and it’s an active area of research. But the question of whether the plaque itself is going to regress or progress or just stay the same, maybe we have this mantra of ‘Plaque Stabilization’ which is important but really aside from the point, I mean it is so well-established. Statins will reduce fatal and non-fatal heart attack and stroke, that is crystal clear. And so really, setting aside the controversy about the details of the artery wall and focusing on the issue of really implementation of optimal statin therapy. That I think is really the primary focus of this campaign that we’re part of and I would argue it’s really the most important clinical focus, if we had to pick one thing this would be it. So statins abound, they’re everywhere. We talked about not necessarily taking the advice of dieticians when it comes to good nutrition. Is that the same deal when it comes to these statins that supposedly reverse or at least alleviate many of the symptoms and the plaque itself? Yes. Even though you would think it is, so you could take that statin and in fact, it’s not because first of all, the high cholesterol is a systemic. You don’t have symptoms when your cholesterol levels are high, you can’t look in the mirror and say, ‘Gee. it looks like my cholesterol is going up’. There are of course impacts of both diet, and exercise and obesity but there are no symptoms. So if I take my statin or do not, I don’t feel differently in fact and maybe having a side effect on my statin and I may feel worse when I’m doing the right thing. So the question is what do we do or what other thing by doing very, very important is that so many of our patients will assume that after a few months or maybe a year or two that they’re done. And it’s true that there’s benefit and there may be a little carryover of the benefit but it’s never enough. Statins can’t work when the patient doesn’t take them and that we really are obligated to stay with ongoing statin therapy for life. I mean, unless some large change occurs in our diet, or our lifestyle, or a weight or something else drastic happens, if we needed a statin a year ago, we still need it today. And there’s so much likelihood that would stop the statin, the patient who persists on statin treatment long term is more likely the exception rather than the rule, it’s a neighborhood of half a patients are not taking statins after a single year of starting. There was a recent survey that was conducted that I guess shed a little bit of light, a little bit more in depth as why this non-compliance is such an issue especially when our lives are at stake? Well, the survey was very interesting. A little discouraging but we need to know what’s going on and the survey was focused on communication between the doctor and the patient. And I would say that there’s a very important and really burgeon takeaway for all healthcare professionals and that is that only about 1 out of 5 patients knew how they have heard from their healthcare provider that there was more than one statin and only 1 out of 6 had any notion that it was possible to have an adverse interaction between a medication and a statin. And of course, part of the same story is being aware that some of these drug interactions might differ from statin or perhaps also the side effects. And so, the bottom line here is that patients are simply not aware that there are alternatives. So if a patient has a problem or concern with whatever statin they started with, so very often, they do not know that there’s another option and that of course can have disastrous consequences when it comes to their long-term adherence to the drug. Now talking about this survey, the results of this survey relate directly to the, there’s an initiative, and awareness and educational initiative surrounding cholesterol, best practices and more information. Talk about this initiative that you’re part? Well, I’m really pleased to be teamed up with Kowa Pharmaceuticals America on this program that we’re calling ‘Take Cholesterol to Heart’ and there’s a website of the corresponding name. And this particular program that we have is designed really to reach out to the patient. So that focus is on the patient reaching out to the lay public, anybody who has been prescribed a statin, anybody who knows somebody who is maybe a family member, or caregiver or trying to reach out to them. And in a word we’re trying to open up communication between doctor and patient, that is the focus. Now exactly, how does this work for an audience of healthcare professionals? I think we should be aware of this program. I think we should take a visit to the website, see what’s there and perhaps direct patients to the website as an adjunct to what we’re trying to do in the clinic. Takecholesteroltoheart.com. Just like it sounds right? Yes. That’s to as TO, instead of the number two. Okay, great. Takecholesteroltoheart.com When is the best time to have your cholesterol checked for the first time to find out if there is any elevated cholesterol and when is it too early to start managing it or is it ever too early? The quick answer to that last question is no. My answer to your earlier question is probably sometime after birth. We don’t need to measure cholesterol in utero but once somebody is born at any time really they can be tested We sometimes talk about age 2 and that’s fine but you can test earlier. We’re talking now about ages 9 through 11 for kids but again, you can test earlier or later. Anytime, it’s probably good to be tested at least once as a child. And then among adults, we suggest testing every 5 years or so if everything is normal, then repeat it 5 years from now. And if you’ve never had a test, tomorrow is a great day to get that going, get that test and then sit down with a doctor. So what we’re trying to do is encourage all of our patients to be tested, so again … for the healthcare professional is this make sure that your patient that you’re busy treating for whatever disease, it doesn’t seem related to cholesterol in very, very few if any cases is that protect them against the high cholesterol level and usually does not protect them against heart disease or strokes. We’re saying everybody should be tested and once that test is done, then it needs to be a heart-to-heart conversation between the patient and the healthcare team. And ideally, the doctors of course leading that process but any member of the healthcare team can and should be involved in communicating with the patien. We want to find out what medications the patient is taking because there’s potential for adverse interaction with the statins. We want to know if the patient has concerns, fears. If they’ve stopped their statin, we’ve already prescribed that or think about stopping the statin maybe they’ve heard something from a friend or read on the internet that statins are going to kill them or … their liver or whatever, we have to address those concerns with the patient and not just once as we start the statin but again and again because it is so common that a patient will stop taking a statin sometimes without telling anybody, they just stop it, they come back, we didn’t ask them, ‘Are they still alive?’ We want to give them permission to do that. The website connected to this program is excellent in terms of facilitating that communication. Well, I sure I appreciate you coming in today Dr. Brinton giving us this great information and also giving us the opportunity to check out takecholesteroltoheart.com. It’s been a pleasure and I hope you’ll come back. Thank you so much Neal. You’ve been listening to Health Professional Radio. I’m your host Neal Howard. Transcripts and audio of the program are available at hpr.fm and also at healthprofessionalradio.com.au. You can subscribe to the podcast on iTunes, listenin and download its SoundCloud and visit our affiliates page at hpr.fm and healthprofessionalradio.com.au.


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