Healthy lifestyle changes may reduce need for statin

I urge to vary on that. If my possibilities of having a coronary heart assault drop from 3 p.c to 2 p.c, I say that may be a 1 p.c drop. So I give up taking the drug due to the long-term unwanted effects. I additionally modified my eating regimen to eradicate sugars and extremely refined carbs, and I’m consuming plenty of darkish inexperienced veggies. I maintain my weight underneath 140 kilos, which remains to be a couple of kilos over my pure weight (about 135 kilos). I’m 5 ft, 9 inches and have all the time been very skinny.

I had a coronary heart assault and triple bypass 11 years in the past, despite the fact that my blood stress was 125/80. My present heart specialist desires to up my statin drug from 40 mg to 80 mg. I’m 78 years outdated and really wholesome.

Nameless

A: An outdated expression is that there are three sorts of lies: lies, damned lies and statistics. What you’re calling nefarious, the drug firm calls advertising, and each methods of taking a look at it are true, so long as you perceive what’s being stated.

The unique examine that seemed on the impact of a statin drug in folks with coronary heart illness confirmed that after 5.4 years, the danger of dying was 12 p.c within the group randomly assigned to statin, and eight p.c within the group randomly assigned to placebo. The paper known as {that a} 45 p.c relative threat discount, however I might name it a 4 p.c absolute threat discount. Different research (there have been many who have constantly proven profit) didn’t present as nice an enchancment (33 p.c relative threat discount is extra widespread than 45 p.c), however you need to have a look at each the size of time a examine goes on and the way sick the topics within the research are.

You should still assume that it’s not price taking the drug to go from a 12 p.c threat of dying to an 8 p.c threat of dying over 5 years. I do know which group I’d slightly be in, so I like to recommend a statin to an individual who has that prime an absolute threat. I might by no means suggest a statin to an individual with a 3 p.c 10-year absolute threat. Most authorities suggest a statin as soon as their 10-year threat is above 7.5 p.c.

You point out long-term dangers. Muscle aches trigger discontinuation of statins in many individuals (who’re then at elevated threat for coronary heart assault in contrast with those that proceed statins), however persistent signs after discontinuation are uncommon.

Individuals at excessive threat of coronary heart assault and stroke profit from statin remedy, however the quantity they profit will depend on how a lot threat they’ve. These with a previous historical past of coronary heart assault or bypass graft are at excessive threat and more likely to have way more profit than hurt from a statin. Individuals with no historical past of coronary heart illness have much less absolute profit, and so a cautious analysis, together with evaluation of life-style points like eating regimen and train, is important. I’ve had many individuals who not met standards for a statin as soon as they made some wholesome adjustments to their lives.

Q: I’ve struggled with IBS and GERD since I used to be a small youngster. I’ve had a number of gastroscopies and have been on numerous medicines over time for my points. I’ve adopted each eating regimen and life-style change that my physician has urged, with, at greatest, average outcomes.

Just lately, a pal of mine urged having my intestine flora screened by a non-public firm for evaluation. This firm takes your outcomes and suggests a prebiotic routine so that you can assist enhance your intestine’s microbiome. Nevertheless, these assessments are costly, and I’m leery about spending $200 or extra on a check equipment which may not be as beneficial as these firms declare.

The opinions on-line appear combined, with some sources raving their efficacy and different sources saying these assessments are restricted in scope and of doubtful worth. What’s your opinion on at-home non-public intestine flora screening? Is it price doing?

NE

A: There’s nice pleasure concerning the microbiome (the time period for the “suite” of hundreds of bacterial species in your gut) however nonetheless a substantial amount of uncertainty. Specialists estimate 40 p.c of the genes recognized within the microbiome have unknown perform. There’s not a consensus about what makes a “wholesome” microbiome or an “unhealthy” one. It’s additionally not clear that an “unhealthy” outcome out of your microbiome testing is the reason for, or the results of, intestinal illness. It’s also very unclear that attempting to govern a particular microbiome outcome via eating regimen or probiotics results in higher outcomes than normal nutritious diet recommendation.

I depend on proof, and the proof that your $200 on testing will lead you to higher well being will not be robust sufficient for me to suggest them presently.

Q: My latest DEXA scan stated I had a 19 p.c probability of a serious fracture throughout the subsequent 10 years. Does that imply that I’ve an 81 p.c probability of not having a serious fracture?

MEH

A: Sure, that’s precisely what it means, however you need to notice that after the ten years, your threat will proceed to go up. In case you are one of many fortunate 81 p.c who doesn’t get a hip fracture, you could have a considerably increased probability within the following years to get a serious fracture.

Most authorities suggest therapy when the danger of main osteoporotic fracture exceeds 20 p.c, however not everybody will select remedy at that degree. The upper the danger, the extra profit an individual will get from therapy, which includes eating regimen, train, vitamin D and, generally, medicine. Remedy reduces the danger of fracture. In girls with very low bone density, for each 100 girls who took the drugs for 3 years, six didn’t get fractures who in any other case would have.

All medicines have downsides, and bisphosphonate medicine (the commonest class of medicines used; Fosamax is one) improve the danger of a number of issues, together with osteonecrosis of the jaw. These medicines ought to solely be used when there’s a clear profit outweighing the danger, and the 20 p.c threshold is one generally used guideline.

Q: What are some pure methods to cut back blood stress?

JW

A: Too usually, physicians soar to medicine therapy to manage blood stress, when there are nondrug methods of decreasing blood stress which are usually neglected.

Not each particular person with hypertension is salt-sensitive, however total, decreasing salt could make a major enchancment in hypertension — a mean of 5 factors systolic and three factors diastolic from average salt restriction. Different dietary adjustments confirmed to enhance hypertension embrace excessive potassium meals, equivalent to fruits; a extra plant-based eating regimen with extra greens and legumes and fewer meat; and better calcium and magnesium within the eating regimen.

Alcohol can have a particularly giant dangerous impact on blood stress in many individuals, particularly the day after consuming three or extra drinks. Smoking additionally raises blood stress, and quitting has many well being advantages past the drop in blood stress. Common moderate-intensity train (40 minutes three or 4 occasions weekly) equally improves blood stress.

There’s proof for profit from some dietary supplements. A examine on aged garlic dietary supplements was methodologically robust and confirmed a drop in systolic blood stress a mean of 5 factors. Smaller trials confirmed profit with the dietary supplements berberine and whey protein. Darkish chocolate and decaf espresso/tea have small helpful results.

Lastly, some varieties of meditation have been proven to assist decrease blood stress. Even sluggish, deep respiration strategies can decrease blood stress within the brief time period.

Not all people with hypertension can keep away from medicines with these pure cures, however there are numerous who can, and lots of of those pure cures have extra well being advantages past blood stress.