Reducing Cardiovascular Risk: Lifestyle and Statin Deep Dive

"Cholesterol Treatment Options" is a comprehensive guide to understanding the available treatments for high cholesterol. The episode explains when treatment is needed, the importance of lifestyle modifications, and a focus on medication options, including statins. This episode aims to help listeners make informed decisions about their cholesterol management and take control of their cardiovascular health.

Takeaways

Statins are effective in preventing heart attacks, strokes, and death.
Lifestyle changes are crucial for managing cholesterol levels.
Regular exercise and a healthy diet can significantly impact cholesterol.
Understanding your cholesterol levels is important for heart health.
Patient education is key in making informed health decisions.
Statins have minimal side effects for most people.
It's essential to have open conversations with healthcare providers about treatment options.
Dietary modifications can lead to significant improvements in cholesterol levels.
Reflecting on personal health habits can inspire positive changes.
Regular check-ups are important for monitoring cholesterol and overall health.

Keywords

cholesterol, statins, lifestyle changes, heart health, patient education, cardiovascular disease, LDL cholesterol, health podcast, medication side effects, dietary modifications

Transcript

Ed Delesky, MD (00:05)
Hi, welcome to your checkup. We are the Patient Education Podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky a family medicine resident in the Philadelphia area.

Nicole Aruffo, RN (00:19)
and I'm Nicole Aruffo.

Ed Delesky, MD (00:21)
And we are so excited you were able to join us here again this week. You enjoyed yourself quite the day, yes, well two days ago when this comes out. You a great Saturday.

Nicole Aruffo, RN (00:31)
We had ourselves a day.

Ed Delesky, MD (00:33)
We did. Why don't you go ahead and tell us a little bit about your experience.

Nicole Aruffo, RN (00:38)
Well for my birthday, Eddie got me a visit to one of those head spa things.

Ed Delesky, MD (00:44)
For someone who doesn't know what a head spy is.

Nicole Aruffo, RN (00:47)
Um, well, it's probably the greatest thing that'll ever happen to you because it was the greatest thing to ever happen to me. And you're laying down and it's basically like when you're getting your hair washed, like at the hair salon, but times a million. And they, they have that like halo, like, um, what's it called? A hose? I don't know. That seems.

drastic to call it a hose. Okay. So like pour water over you so it gets like your whole head at the same time. Wow. And they're like scrubbing you and using all these tools and it's cool because you they have this like microscope probe thing that they put on your head before and after. Yeah. Looks like so that was cool because the whole thing is about like your scalp health and like blah blah blah blah blah. But it was actually crazy because

Ed Delesky, MD (01:32)
I didn't see any of it, but this looks cool.

Nicole Aruffo, RN (01:42)
before you could see like I had washed my hair the day before and You could see like my scalp was kind of dry and there was some product build up and Then after it was like squeaky clean. It was crazy

Ed Delesky, MD (01:59)
Did they just do the scalp or were there other things involved with this experience?

Nicole Aruffo, RN (02:04)
yeah, it was a full, I don't know if they like accidentally gave me an upgrade because I don't think that this was included. But so she's like doing the thing and then they put this steam thing over you. I'm not doing a very good job of describing this, but it's fine. But then she started rubbing me. She gave me a whole like neck, shoulder, upper back, arm, hand, like finger massage.

Ed Delesky, MD (02:32)
I didn't know about the finger.

Nicole Aruffo, RN (02:34)
Well, yeah, I mean, they get in your hands and then, you know, like when they like pull your fingers. She did that. And then she brings out these hot stones and does that whole massage all over again with the hot stones. And I'm like, okay.

Ed Delesky, MD (02:48)
Yeah, this wasn't a slouch. This was a whole hour. Yeah. Well, actually, it was over an hour. Yeah, it was definitely more than an hour, which kudos to them. I'm glad they took care of you. I'm so happy you had a great time.

Nicole Aruffo, RN (02:52)
It was probably like an hour and a half.

It was so great. And

my hair really does feel like so smooth. Even like, so I styled my hair yesterday and then I worked out today and was sweaty and it's still like so smooth and clean feeling.

Ed Delesky, MD (03:16)
Did they use any product in your hair to like treat it at all or this was just from like them?

Nicole Aruffo, RN (03:22)
I mean, I don't know what they did other than just using like shampoo when I was back there, but then she put like a leave-in product before I left.

Ed Delesky, MD (03:32)
That's awesome. Wow. So you love that.

Nicole Aruffo, RN (03:35)
I loved that. Gotta go back. I think you would like it. There was a guy there when I went back.

Ed Delesky, MD (03:41)
No, it's I mean like I

mean, yeah, who wouldn't? mean, this isn't why. Why not? I would. I did. I saw there was a couple there. and then this other guy came in a similar situation. So.

Nicole Aruffo, RN (03:53)
Except

not similar. So Eddie got this for my birthday. So like he was paying for it and then he took me down there and then just stayed and waited for me. And then he said that there was, I guess, similarly a couple that came in and they went up and the, what did he say? You say it. wasn't there.

Ed Delesky, MD (04:11)
Yeah, he was like she sits down and she's gonna get the treatment and then I don't know though like there seems like a little tension in the interaction and then He goes and turns to the lady who's at the counter and he's like, yeah. Yeah. I'm gonna pay for half of hers and I'm like Go all the way if you're gonna do a gift, I don't know I thought and then he left

Now I thought he was in a cozy, it was like this couch, this couch that I was sitting on. And I thought he was gonna cozy up next to me on the couch and we were gonna make like most micro talk possible. I could talk to a brick wall probably. But he left, so then I sat there and did some other stuff. Got ready for this episode actually, is really what I did. But that was awesome and then I did have you walk back. By the time you realized that we were walking back, we were almost already there. So that was clever on my part.

And then we went to dinner. We, by the time we went to this restaurant last time, we weren't doing this. We weren't, we didn't have the podcast. It's called Suraia. And I'll say the proper name here just because I, for anyone who goes S-U-R-A-Y-A. It, I mean, for us, it was touted always as probably the best meal. Yeah, we've had, there's a tasting menu that you have to go through. They give you a few different options. It's Lebanese food.

Nicole Aruffo, RN (05:26)
single pin.

Ed Delesky, MD (05:34)
It's so good. Yeah, there's no shortage of food either. I. Tabula. Well, obviously, tabula is a food, I took my interpretation of the word of tabula to mean throw my hands up in the air, sit back, unbutton the button, undo, go for it like one loop on the belt buckle further. I'm cooked. I'm done. I'm full. Tabula. Obviously, that's not what tabula means. And if anyone is Lebanese who's listening, thank you.

Nicole Aruffo, RN (05:39)
You get so much food.

Ed Delesky, MD (06:03)
for the use of the word, but tabouleh, that was so good. What was your favorite one? Well, describe what the dish

Nicole Aruffo, RN (06:10)
I don't know how to say it.

I can't even describe it. There were chickpeas in it and it was amazing. that's all I have to say. Yeah. F-A-T-T-E.

Ed Delesky, MD (06:18)
Fatteh.

Yeah,

I pointed to the things on the menu when I was pronouncing them. There's no shame here. And then the brand Zeno is the thing that like I we've had. Yeah, we've had a bunch of brands, you know, around now since then, just because I'm like interested in the mic. all brands, you know, must taste like this. Not true. No, they're not like Soraya's bronze, and their lamb kebab, which was absolutely delicious. I literally thought I was going to get little hunks of meat on a stick. No.

Well, they actually did have like a tube like shape to them, but it crumbled it was very it was so tender I Mean it was all incredible. They like we were sitting at the chef's counter so we could see the

Nicole Aruffo, RN (07:05)
the HBIC chef. Yes, that was actually kind of cool. They had like the two HBIC chefs and then I guess they like, you know, like the cooks are like making everything and then those two guys have to like approve everything and they put the garnishes on with their little chopstick looking things and like they like place everything meticulously on the plate and you like watch them do it.

Ed Delesky, MD (07:24)
I just...

Yeah, it's awesome. I mean, there's a couple, like I think the menu and I guess we haven't watched this, the bear, but like people are more into.

Nicole Aruffo, RN (07:37)
Oh

my god, people were saying yes chef. To the HPIC chef.

Ed Delesky, MD (07:39)
The Life of a Chef.

Which is crazy. It was cool to see. It's like a, I guess it's like a first name. When they address it as a title, it's not like, Hi, Dr. Delesky And it's like, no, yes, chef. It's kind of anonymous almost. Like you're just one of the chefs. Like you are, you have become one in the community. You are chef. Not the chef, right? There's no article in front of it. It's a yes chef.

Can I get a yes chef? my god. Come on. Come on, give me one. So then there was the, I was absolutely full already. And then obviously our server was incredible. He was so kind. I probably like had no shortage of, well, there's like little eight ounce glasses of water and I'm surprised they just didn't put the pitcher in.

Nicole Aruffo, RN (08:11)
I don't know.

Yes, chef.

I know he came by like every seven minutes to fill up Eddie's water glass.

Ed Delesky, MD (08:35)
Yeah, I'm gonna go gone. And then there was like a thick cheese to top it all off. really, if there was like an ice cream based dish, that would have been awesome. Yeah.

Nicole Aruffo, RN (08:44)
I guess that was a more traditional Lebanese.

Ed Delesky, MD (08:48)
With the savory cheese at the end. Yeah, but all in all I can't this this place is amazing. It's so tasty worth every penny I

Nicole Aruffo, RN (08:58)
We have to go when it's nice out because on like the back patio situation I think they've I'm told they have a different menu out there.

Ed Delesky, MD (09:06)
Yeah, and I've heard we've talked about this outside of these when we have like a billion other conversations outside of the recorded ones that they have the brunch that we'd like to go to. Some of our closest friends were supposed to go there, but I guess they flexed to a different place last minute. And no, that place was awesome. Our intern is here for all those who are worried. He's floating around licking a lick pad. He's getting ready for the Super Bowl. By the time this comes out. It's Super Bowl Sunday. By the time this comes out.

someone will have one and a lot of our audience is in Philly. So I'm not sure what it will look like. But here we go.

Nicole Aruffo, RN (09:44)
I'm excited to make the buffalo chicken dip now. We were in a conundrum and I was kind of upset earlier because I didn't plan everything ahead. I had everything else to make buffalo chicken dip, but we didn't have buffalo sauce. We were out and about yesterday. So we went this morning and shockingly to nobody, there was no buffalo sauce anywhere in the city.

So then I finally came to terms with that we just were not going to have buffalo chicken dip. We had these other things to have while we watched the game and have a Super Bowl Sunday. But then I remembered that we live in an ingredient household and it turns out that we have all of the ingredients to make buffalo sauce. So that's actually what I'm going to do after this.

Ed Delesky, MD (10:32)
Yeah, this is awesome. I mean, was the one thing I asked for. did not like, there was no shame. I wasn't going to throw a hissy fit, a tantrum about Buffalo chicken dip. Perhaps it would come later in the week. I mean, we got great Valentine's Day plan. I mean, we could just chit chat all day long. I know what the people came for. I'm so excited for this. Like literally from scratch.

Nicole Aruffo, RN (10:55)
Good, I think it'll be good.

I just love that I have gotten to the place now for a while where like...

If we don't have something, I just make it. Yeah. Because we have the things. That's awesome. And that's the perk of living in an ingredient household.

Ed Delesky, MD (11:11)
I really never heard of it called an ingredient household before, but.

Nicole Aruffo, RN (11:15)
No, are like do you like did you grow up in an ingredient household or I? Guess a meal household is the other we're like do you just like have things to like make a meal or make food or do you have like? Had a big weekend lots to talk about

Ed Delesky, MD (11:31)
big weekend. We're happy birthday, Chloe. I'm not sure if you're listening, but. Hope so. Those Vermont beers were delicious. I can't get enough of that, but it was nice to get some of the crew back together and have a lot of laughs. Definitely about topics that will not be discussed. On this podcast, but maybe other podcasts clearly because that's where the ideas were coming from. All right, so. Maybe maybe it's time.

Nicole Aruffo, RN (11:36)
she better be listening.

No, certainly not.

I think so.

Ed Delesky, MD (12:02)
our intern just joined us for the actual content. So, Nick.

Nicole Aruffo, RN (12:07)
Ed.

Ed Delesky, MD (12:08)
What are we going to talk about today?

Nicole Aruffo, RN (12:11)
While we're

Well, we're continuing our cholesterol journey and talking about treatments today.

Ed Delesky, MD (12:21)
Yep. Today we will talk about both lifestyle and medication treatment. So big meaty episode if it wasn't meaty already. Meaty. Treating cholesterol is incredibly important. And like Nick said, we're going to talk about high cholesterol again. We're going to talk about LDL cholesterol focusing on that. Maybe some triglycerides and what medicines are out there to do that as well or what lifestyle changes and how these increase the risk of heart attack, stroke and other cardiovascular diseases, which we defined in previous episodes.

Feel free to go back and listen to those to catch up. So I guess the first topic of conversation is when is treatment for high cholesterol needed? So at this point, it's an individualized decision. It is a case-by-case basis. are different recommendations made by different societies. there are bunch of... So there are a lot of factors to consider, especially current lipid levels, particularly LDL cholesterol and triglycerides.

Well, people tend to think about the presence or absence of cardiovascular disease itself. The someone's individual risk of developing a cardiac event goes into this discussion and other risk factors as well. Like if someone has diabetes and they're over 40, people are thinking about a medication or if they have high blood pressure, it contributes to your risk. And maybe it's time to add a medicine to treat cholesterol. And so

There's also patient preference. Like I've had multiple conversations in this past week with people who were in like schmedium risk and otherwise stated like borderline or intermediate risk. And it's a conversation about how to manage cholesterol. So determining who gets treated is one thing. But then there's another thing to consider of how aggressive are you with treatment? And so people sometimes have more aggressive goals.

when it comes to people with cardiac disease already, if they have diabetes or something called familial hypercholesterolemia. What the heck is that? It's a genetic condition where like everyone in the family or anyone who is affected in the family has really high cholesterol. Those people get more aggressive treatment. Basically what I'm trying to say is there's a lot of factors that go into it. It's that conversation that you have with your trusted physician or whoever's taking care of you to decide whether you medicate.

or not when it comes to your stat, when it comes to cholesterol. How's that sound?

Nicole Aruffo, RN (14:54)
think that sounds great. Okay.

Ed Delesky, MD (14:57)
So why don't you take us a little bit through. People get really excited. We're not excited. People, as doom and gloom, actually, they get the lipid profile. They're like, oh my god, why is my LDL high? And then they're just kind of waiting for the medication question. Or they're going to be told that they have to the medication. But if someone wanted to think about all the things that go in their body and everything they do in their life,

What things can we do to actually, lifestyle changes to lower cholesterol?

Nicole Aruffo, RN (15:33)
So there are three specific lifestyle type changes. The first is or are the dietary modifications. reducing your total unsaturated fats, limiting refined carbs, excess calories, and alcohol. So increasing fruits and veggies. I guess there is some evidence to show that a plant-based diet can lower your LDL cholesterol, which is the bad one.

Ed Delesky, MD (16:02)
Yeah, that makes sense. If you're just taking in less fat, then your cholesterol will likely go down. So when it comes to doing stuff like this, we've talked about calorie inventories before. I've recently been starting to talk with patients about fiber inventories that you have to assess what's going on in your diet. So if you're going to be serious about this, maybe you get an app. We don't have any specific one to recommend, but a food counting app.

Assess what actually is going into your body every day. And take a saturated fat inventory instead of counting calories. Some people count sodium. See how many grams of fat are in your food. And if you want to be serious about this, find it where it is in your life. Because you're going out and purchasing this stuff. It's in the house somewhere. Or you're going out and buying this food. So what else can we do with dietary?

Nicole Aruffo, RN (17:01)
So we have dietary modifications and then exercise. So regular exercise is beneficial. And then the third is weight loss, which should hopefully just come naturally with a dietary modification and exercise. Yeah. Yeah. So I would say, I mean,

Not that I know anything, but I would say the dietary modifications are probably the biggest one. Right. Because it goes into like what you're putting, like what you're putting into your body. Totally. Like what you have put into your body for the last however many years, like got you to this place. Right. Most likely.

Ed Delesky, MD (17:28)
Yeah.

And it's not too late. And I feel like sometimes there's some apprehension when it comes to going to the doctor. And some of this is baked into like the knowing the unknown. Like if you don't know what your A1C is, if you don't know what your LDL cholesterol is, if you don't know what your cardiac risk is, then maybe it doesn't exist. And that's not true. I try to be as welcoming as possible. know that maybe that's not everyone's experience. But you should go get checked out.

Go get checked out so that you can find out what things there are to work on. Because especially if you're at a certain age, there are risk calculators that can be used. You can adjust these risk factors. It's a yellow flag up in your lifestyle. like, hey, that burger every week that you're getting from Five Guys, maybe it can't be every week anymore. Maybe it needs to be once a month. So they're important because

truthfully, every, like when I sit with a patient and I talk with them, it ends up being, talk with them a lot about medicine, but I really try to impress upon them that that's because that's the time that we have and we have time to like make decisions and answer questions. And that's why we do this episode and we do like this medium so that we can talk about these lifestyle changes because that's the first thing. Like you should take a beat and take six to 12 months and reflect and say like,

Is there something I'm doing at home that I can change?

Nicole Aruffo, RN (19:14)
And the answer is probably yes.

Ed Delesky, MD (19:15)
And answer is probably

yes. And you just have to be honest with yourself and reflect that like.

Nicole Aruffo, RN (19:20)
because like

most of the time. If your LDL is high, it didn't just happen.

Ed Delesky, MD (19:31)
Mm-hmm. It's not because you ate that day. Like if you go get it in the afternoon and you had lunch and you had dinner, like that one's not moving. Treglycerides maybe. But this is stuff that happens over time. And it's not too late. The answers are within you. you just have to get ready to make significant changes in your life when you're ready.

Okay.

Nicole Aruffo, RN (19:56)
And if, you know, maybe you don't want to make those lifestyle changes or maybe you do and it's just not working.

And there are some medicines,

Ed Delesky, MD (20:07)
Yep, that's a professional.

Nicole Aruffo, RN (20:10)
Yeah,

you like that? I like that.

Ed Delesky, MD (20:13)
So, like you said, very specifically, if the lifestyle isn't working, or just if you have certain disease, and it's time to think about a medicine because your doctor or nurse, physician's assistant, whoever's taking care of you, is saying it's time to start thinking about medication. And the number one medication we are going to spend the most time talking about

because this is directly going to lead into our next like misinformation episode, because there are people out there slandering these great medicines. Is the statin medication. This goes by the name of like Rosuvastatin, Atorvastatin, Pitavastatin. They all have brand names. not going to go into what those like Crestor or Lipitor. Those are the brand names of the most common ones. Sorry, I was just kidding.

Nicole Aruffo, RN (20:45)
God.

There's a

whole community of ill-informed people on the internet who are strongly against statins.

And it's actually crazy.

Ed Delesky, MD (21:18)
And we got a message from your mom about like this lady who's out here just like she's like one of these homeopathic who has who like we have no idea what her credentials are, but she's on everyone's screens talking about statins. And so what we're going to do is we're going to break down at least this medication and probably a couple others. We are going to break down their effect and the side effect, because when we talk about medications in general.

When a doctor mentions medication, nearly the first word out of someone's mouth is, what are the side effects?

Nicole Aruffo, RN (21:54)
Yeah. But like, what is the side effect of your high LDL? Like death, probably.

Ed Delesky, MD (22:02)
Heart attack, stroke, peripheral artery disease. Exactly.

Nicole Aruffo, RN (22:06)
So like, what do you want? Which one?

Ed Delesky, MD (22:09)
So what it can't be lost is the effect. And what is the effect? So we'll start here. Statins are the most commonly used and most effective medication for lowering LDL cholesterol. We've defined that all over the place. That's the bad cholesterol. And this is how I describe it to people. I usually don't tell them that it just lowers their LDL. This medicine prevents heart attack, stroke, and death. And say it again. Statins prevent heart attack, stroke,

and death. They lower LDL by about 25 to 55 percent and it's different in different people and they also lower triglyceride some. How they work is that statins work by decreasing cholesterol production and increasing its removal by the liver. We won't get any more complicated than that but they are very simple affordable medications that have been around forever and that's the effect. Let me say it again. Statins

prevent heart attack, stroke, and death.

Nicole Aruffo, RN (23:10)
And before you say that it's just a ploy from Big Pharma, blah, blah, blah, Like you said, they've been around forever. They've been generic for a long time. They're not expensive. This isn't like some specialty med that Big Pharma is like, I mean, I'm sure they are making money from, like, you know, it's not like these other crazy expensive meds.

Ed Delesky, MD (23:38)
Right. what I want now, that's the effect. And it's so important. these these medicines, for some reason, people and I see here because we're to talk about them, we're to talk about these side effects. We're going to talk about the ones that are rumored. We're going to talk about the common ones that like we all counsel people on, but the ones that are out there and need more context because otherwise they just get a headline of statins cause this and there's no context. There's no information. There's no data.

You're getting that today. So. I guess it's reasonable to move on to the side effects, I guess. Yeah. Well, the top line is that statins are actually very well tolerated. Shocking. Like people oftentimes just take these medicines and nothing changes at all. They don't feel any different. They're just now taking the medicine, which may be a lot of different, different for people. There is something as like pill inertia. You go from zero pills to one pill.

Nicole Aruffo, RN (24:15)
Let's talk about them.

Ed Delesky, MD (24:36)
That could be a big deal for someone. But the side effects do vary in frequency and severity. So the first umbrella of side effects are statin-associated muscle symptoms. This is the most common one. And this includes something called myalgias. Myalgias are muscle pain with a normal lab level. Sometimes we have to look into the labs if people are having muscle pain. But how often does this occur? One to 5 % in the clinical trials.

In real life, five to 10 % maybe. So that is five out of 100 people. Flip it. 95 people out of 100 don't get muscle aches. So sit with that for a second. Like if you're going to

Nicole Aruffo, RN (25:22)
And honestly, all right, let's play it again. Muscle ache, heart attack. Muscle ache, stroke. Muscle aches, dying.

Ed Delesky, MD (25:33)
There you go. Like, yep. Even more rare than those. Sometimes the muscle aches can be associated with some elevated what's called a CK level. And that goes into an inflammation of the muscles. And then less than point one percent of the time is one in a thousand people. One in a thousand people have very high CK levels in something called rhabdomyolysis.

extremely rare, extremely rare, but that's why these are prescription medicines. And you can't just go to the pharmacy and pick them up like Tylenol or Motrin or Advil. So the next side effect I'd like to talk about is liver injury. Again, this is why this is prescription medicine. It is extremely rare. The risk of liver failure probably can't even be associated with this, but it is 0.001.

percent. I don't even like that is that is one hepatic failure is one out of 100,000 people. So yeah, we're being transparent here. Like that's been described. But it's that rare.

Nicole Aruffo, RN (26:51)
That was a long growl.

Ed Delesky, MD (26:52)
Something else people will see. Do have any thoughts about the liver injury?

Nicole Aruffo, RN (26:56)
no, I mean, again, weigh your risk. There's a one in 100,000 chance that you'll have some sort of injury to your liver, but there's a higher chance that if you don't take your statin, you'll have a heart attack or a stroke or die.

Ed Delesky, MD (27:16)
So this next one actually, I think, has raised a point of conversation for a lot of people. There has been described a new onset diabetes association with statins. And what I'd like to say to this is to add context to the picture. The increase in risk is modest. I think it already happens in people who have risk factors for diabetes, including those who have and are managing obesity.

who are managing an impaired fasting glucose or have impaired have insulin resistance already or people who have metabolic syndrome. To put numbers to it, the risk is about 0.2 % per year. So 0.2 % per year comes out to be one out of 500 people. So that means that 499 people

out of 500 every year who are taking a statin will not develop diabetes. And the odds are that they probably had something going on inside already that was predisposing them to getting diabetes anyway. Insulin resistance, metabolic syndrome, having obesity. And so what's the thing we've been practicing here with this episode? What are we weighing?

Nicole Aruffo, RN (28:40)
We're the risks of statins. Wait, what did you say it was? One in 500 people?

Ed Delesky, MD (28:46)
one in 500 every year.

Nicole Aruffo, RN (28:48)
Okay.

That's why your one in 500 chance of getting diabetes this year from this medication or keeping your LDL high and dying. Which one? You're also like, again, like you said, if your LDL is high and you have other risk factors and maybe live a lifestyle that's.

Ed Delesky, MD (28:55)
this year.

There we go.

Nicole Aruffo, RN (29:19)
I don't know the word I'm looking for. Not so healthy. You might be on your way to diabetes anyway, so.

Ed Delesky, MD (29:25)
Is it the statin that's gonna tip it off? Exactly my point.

Nicole Aruffo, RN (29:27)
Probably not the statin. It's probably

the

five guys cheeseburgers you're eating every week.

Ed Delesky, MD (29:36)
There we go.

So there's this other one that I think is interesting. And mind you, all of these are from the New England Journal of Medicine. I'll clip that and put it in the front, all these side effects listing. Cognitive side effects. There are reports of rare memory or cognition issues. This comes up in the lay media. People are worried about it. And they looked into these with randomized controlled trials and found it to not have a significantly increased risk.

of statins associated with cognitive side effects. What I will also say is that we have an aging population. As people get older, cognitive issues become more prominent and more prevalent. And we will define these terms for you in the future. We will have episodes. I had a great lecture recently that kind of gave me the inspiration to do that. But as people get older, these become more common.

more people as they're older are on more statins, it is easier to try to pin it on the statin, and I don't think it is. And they looked at this in research and found that it's probably not true.

Nicole Aruffo, RN (30:45)
And okay, so if you get to the point where your doctor sits you down, says we think it's a good idea for you to take a statin. And if you're kind of looking at the side effects that all have a very minimal chance of happening, and if you don't like them, that's fine. However, if you're at the point where you need to take a statin, I know there are, you know, like the hereditary portion, sometimes there are things that you can't control, no matter how great your lifestyle is.

But for the most part, the lifestyle that you've had for the past X amount of years has led you to this point. And the risk associated with that is higher and more dangerous than these very minimal risks from a statin.

Ed Delesky, MD (31:34)
You bet. That makes a lot of sense. So there are other rare side effects that have been mentioned alongside the names of statins, including renal dysfunction, cataracts, tendon rupture, hemorrhagic stroke, interstitial lung disease, and all have not been definitively linked to statins. And so there is a great New England Journal of Medicine article.

Nicole Aruffo, RN (31:36)
know if that was too harsh, but like.

Ed Delesky, MD (31:57)
that overall says, statins carry a low risk of serious side effects and the benefits in preventing cardiovascular events generally outweigh the risks. That's not me, that's not Nick, that's the New England Journal of Medicine talking. So take that and do what you want with it because we don't get sponsored by Big Pharma, I don't have a relationship with them. Right, but the choice ends up being you and whether you.

Nicole Aruffo, RN (32:19)
You would have so much money, my god.

Ed Delesky, MD (32:25)
take the medicine because you see the value in it, or you change your lifestyle because you see the value in it, and then go from there. And this isn't meant to be punitive, this is meant to sort of be a reality check when it comes to all of this, because I wish I could have this detailed of a conversation with everyone who I'm talking to, but it ends up being a little snippet of like.

Nicole Aruffo, RN (32:47)
Well now you'll have something to refer them to.

Ed Delesky, MD (32:49)
You

bet I will. And the last point that we'll make today is the importance of sticking with treatment. This is a lifelong process. Honestly, cholesterol management really forever, probably. And it doesn't have to always be the medicine. Like if you make significant changes to your lifestyle and your body and like if you manage your obesity and your BMI is 35 and you get that at 27 and you did that without medication or with medication.

then yeah, that's a situation where it's managed, but in a different way. Something that's important, think we're gonna spend a little time talking here about it, is that stopping your treatment will cause your lipid levels to rise and it will increase your risk of heart attack and stroke that you were protecting with the medicine.

Nicole Aruffo, RN (33:43)
So if you don't like taking the medicine, you should make some serious lifestyle changes. Because like, does that happen and you like take people off if they've like made a big change?

Ed Delesky, MD (33:53)
Totally. Yeah. I mean, especially when it comes to the GLPs or if someone comes back and they're like, I stopped drinking 40 beers on the weekend. I don't smoke anymore. And like I went from like 280 pounds to like 220 pounds. Like, yeah, if they're on it for like primary prevention and they're which is like no one has disease yet, but like their risk comes down. I'm hoping for a conversation about that. But like that

dramatic lifestyle change, change to body composition would have to happen. And at the end of the day, today, we spent a lot of time diving into the statin. I think that was probably the best use of our time and your attention. There are a lot of other medicines that are involved. Frankly, none. Well, none have the combination of value, affordability, tolerability and effectiveness as statins. There are other ones out there.

don't get us wrong. They go by different names. They work in different ways. A lot of people are on different medicines. We're not going to talk about them today, so I don't overwhelm you. But we really wanted to get at the core of balancing. You tell us. Balancing the risk of.

Nicole Aruffo, RN (35:09)
What?

Yeah, the risk of what will happen to you. If you don't make any change, you don't take any medicine, your cholesterol just stays high, maybe gets higher versus taking a very commonly used and safe medication that has very minimal side effects or very minimal chance of a side effect, I guess.

Ed Delesky, MD (35:37)
that

too.

Nicole Aruffo, RN (35:40)
Right? Like which one? Your risk of having like a stroke or dying is higher than if you just take the statin.

Ed Delesky, MD (35:42)
Exactly.

Well, and you see this every day, right? Yeah, you see devastating things every day.

Nicole Aruffo, RN (36:00)
And people will just say, yep, they were noncompliant with their medicine and they had a stroke and now, you know.

in varying degrees of, I mean, that's life changing.

Ed Delesky, MD (36:15)
Yeah. And like this exact conversation, like you can even go back to my my personal statement to get into medical school, like being able to grab a hold of something before anything happens and knowing that you can do something about it and prevent it.

Nicole Aruffo, RN (36:35)
Or people don't have a primary care doctor and that's also another big thing. I give my PCP spiel a lot.

Ed Delesky, MD (36:42)
Hmm. You're gonna like marry one. So yeah.

Nicole Aruffo, RN (36:47)
Well, it's a lot of primarily African-American males. So I think it's a lot of like distrust with the system. Yeah. I found and like what they've told me. Mm hmm. Or they're like scared.

Ed Delesky, MD (37:03)
I see that. I see that a lot.

Nicole Aruffo, RN (37:06)
They're not all bad. Just go.

Ed Delesky, MD (37:09)
Yeah, I know. I wish I could take them off. So in summary, on this very important episode and our culmination of our cardiovascular risk, understanding cholesterol, statins are a great option as a tool if your doctor or whoever's taking care of you thinks that you should use it. And it's proven. It reduces heart attack, stroke, the risk of heart attack, stroke and death.

So if there's something out there, why wouldn't you consider it? But to your point, you led us through that conversation. Lifestyle changes, incredibly important and should be the first thing, should be the most important thing. So if you leave this episode, I hope you leave inspired and at least a little pensive that maybe you need to do some reflecting on where you're at. If you're taking the time and you've made it this far in the episode that maybe you need to take a look in the mirror and see what's going on.

So that was a heavy week of this week. That was a heavy episode of your checkup. Thank you for coming back and please share this with a loved one or a neighbor. Seriously, if you want, if you need someone to have an honest conversation that really isn't afraid to look at the side effects and address them, but also recognize the benefit of medications or talk about cholesterol, that's what we're here hoping to do. But hopefully today you were able to learn something for yourself, a loved one or.

Nicole Aruffo, RN (38:34)
A knee very width, high cholesterol, high LDL cholesterol. Excellent.

Ed Delesky, MD (38:39)
Please come back for another week of your checkup next week. Keep an eye out for any bonus episodes that we may throw out there for you. And most importantly, stay healthy, my friends. Until next time, I'm Matt Delesky. I'm Nicole Aruffo Thank you and goodbye.

This information may provide a brief overview of diagnosis, treatment, and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use.

This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor. And make sure you go get your own checkup with your own personal doctor.

Nicole Aruffo, RN (39:37)
I am not your nurse.