Is your cholesterol in balance?

Jul 30, 2019

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Being unbalanced kept me from falling apart. I usually ride my bike to work. I have a panier over my rear tire. It's a bag that holds a bike lock, a pump, some toilet paper (because you just never know), a spare tire and occasionally a coffee cup. The panier is held up by a frame. Unfortunately, I got this frame off my last bike with smaller tires. The frame for my panier is not quite tall enough to keep the panier bag from rubbing on the back tire. So, I kinda jerry-rigged the panier frame to give it a bit more height. The problem with my design is the frame is really just held together by friction and gravity. But it has stayed together for a couple years. Last week however, immediately after waving good morning to Lance Delamare, my franken-frame fell apart.

Having an unbalanced cholesterol number is not good. Cholesterol is a naturally occurring substance in the body that is essential for life. If you had no cholesterol in you, you would die. Cholesterol helps form bile acids in your digestive system, hormones in your endocrine system and important components of every cell membrane in your body. Your liver can make all the cholesterol your body needs. The cholesterol in the food you eat doesn't go directly into your blood stream. Your liver makes cholesterol for you.

Why does your doctor test your blood for cholesterol if it is essential for life? Why does your doctor care if your blood cholesterol is too high? Your doctor cares about blood cholesterol levels because if they are too high for too long you have higher chance of getting a heart attack or a stroke. Every 7 minutes in Canada, someone dies of cardiovascular disease. That is why we care about blood cholesterol levels. And that is why cholesterol medications are so common.

Statins are the most popular cholesterol medications. HMG-CoA reductase inhibitors, or statins are very good LDL lowering medications. They help reduce hardening of the arteries or atherosclerosis. Statins have been shown to reduce death due to heart attacks and stroke. In fact, if we reduce someone's LDL with statins, we can reduce their chances of heart attacks and strokes by 25% to 35% with five years' use. As effective as statins are, like every other medication, they do have potential side effects. The statins may upset your stomach. Less common, but more serious problems can include liver issues. Your doctor will check your liver function with a blood test. Other signs of liver problems include flu like symptoms, yellow eyes or skin, dark urine and belly pain. If you start getting a lot of muscle pain, please contact your doctor. Severe muscle injury from statins is rare, but can damage the kidneys.

The statins do a good job of reducing LDL. But, what does all this LDL, and HDL stuff mean? Your liver makes cholesterol, and it puts it into the blood stream. Cholesterol is a kind of fat or lipid. Since blood is mostly water, cholesterol doesn't mix well with it. The liver has to mix the cholesterol with proteins to get it to stay in the blood. This mixture of cholesterol and protein is called a lipoprotein. If you take a blood sample and spin it really fast in a centrifuge, it separates based on density. Different layers in the sample have different densities. Low Density Lipoprotein or LDL is often called "bad" cholesterol because it transports cholesterol from the liver to places like the lining inside the arteries. Through a complicated series of events, these cholesterol deposits can cause blockages that slow or stop blood flow. If blood flow to the heart muscle is stopped, that is a heart attack. If blood flow to the brain is stopped that is a stroke. High Density Lipoprotein or HDL is called "good" cholesterol because it transports cholesterol away from the cells lining the blood vessels. This can decrease the chance of blockages.

Statin drugs like atorvastatin and rosuvastatin sometimes get some bad press about their risks. Let's try to put the risks in perspective. If 20 patients with heart disease take a statin for 5 years, we will prevent one heart attack or stroke. That's pretty good. Muscle pain from statins is rare and the really bad muscle damage called rhabdomyolysis happens in less than one in 43,000 patients. There are alternatives to statins, but they don't have the decades of good research behind them. Ezetimibe and the PCSK9 inhibitors do lower LDL, but none of them has been shown to reduce the chance of a heart attack or stroke when used alone. And the PCSK9 inhibitors cost over $7000 per year. Finally, don't pick fish oil supplements or red yeast rice instead of statins. There is some evidence that fish oil and red yeast rice might be healthy things to add to your diet. But neither has been shown to reduce the risk of heart attack or stroke.

Immediately after waving to Lance, I heard "ping, ping". I stopped. An arm from the panier franken-frame had fallen off. Why was my franken-frame suddenly betraying me? Then I saw the light. I wasn't unbalanced anymore. For the past couple years my aging panier bag has been leaning left. The material in the bag is going. The zipper is going. But the left leaning bag still held together, so I didn't bother to replace it. Last week, I threw some bungy cords over the left leaning bag to center it again. Fixed one problem, caused a new one. Apparently, the new centered bag put less twist on the franken-frame. Less twist meant less friction. Less friction meant the franken-frame fell apart over a bump when I waved to Lance. I should have stayed unbalanced.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Heart Research Institute -

Why So Many of Us Die from Heart Disease - The Atlantic -


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