Is a healthy lifestyle all you need to avoid taking statins?
When it comes to heart health, there’s a lot of information out there on ways to improve your diet, up your exercise and otherwise create a healthier lifestyle. Unfortunately, there’s quite a bit of misinformation, too, especially when it comes to statins, a class of medications to help combat the buildup of LDL cholesterol.
Physician assistant in cardiology Eric Shoup, PA, spoke with us on the importance of a healthy lifestyle when it comes to heart health … and why you may still need statins to keep your heart strong for years to come.
Living a healthy life is powerfully protective, but not always enough
“Lifestyle is the cornerstone of every cardiovascular prevention guideline, and for good reason,” said Shoup. “Whether lifestyle is ‘enough’ depends on an individual’s overall risk for heart disease and their specific risk factors like cholesterol, blood pressure, glucose levels, family history and more.”
For some people who are at a lower risk, lifestyle alone may be enough to maintain a healthy heart. For those at a higher risk, medication such as statins offers a level of protection that lifestyle can’t match on its own.
How do environmental and lifestyle factors affect your risk for heart disease?
“Exactly how much your environment and lifestyle affect your heart disease risk, as opposed to genetics and family history, is a common question,” said Shoup. “In large population studies, we’ve found it to be a roughly 50-50 split.”
About half of cardiovascular disease risk can be attributed to five modifiable risk factors:
The other half is genetic and family history, which are different but share significant overlap. Shoup noted that those with a strong family history of heart disease should be especially mindful.
What kind of improvements can lifestyle changes achieve?
“A healthy lifestyle is strongly and consistently linked to lower cardiovascular risk,” said Shoup. “When looking at a large group of trials that together involved about 2.5 million people, those with the healthiest combination of lifestyle behaviors had a nearly 60% lower risk of cardiovascular conditions when compared to the least healthy.”
These benefits come from the combined effects of multiple choices and behaviors:
- Heart-healthy diet: The Mediterranean diet, DASH and plant-based diets rich in vegetables, fruits, whole grains, legumes, nuts or fish are all considered great options
- Regular exercise: At least 150 minutes per week of moderate activity
- Weight: Maintaining a weight within the healthy range for your height and shape
- No tobacco use: Even if you currently smoke or use tobacco, quitting now will benefit your overall health significantly
- Sleep: Sticking to a good sleep routine and getting enough restful sleep
- Limiting certain foods and drinks: Limited amounts of alcohol, salt, added sugar or processed food
These behaviors alone will improve major risk factors such as cholesterol, blood pressure and blood glucose levels, which is the reason your doctor is generally going to push for lifestyle changes as the first line of treatment when it comes to lowering your risk for a serious cardiovascular event.
Sometimes, medication is still needed to keep your heart healthy
“Lifestyle changes can improve risk factors, but they can’t always do everything alone,” said Shoup. “Some conditions are more driven by genetics or biology, beyond what diet and exercise can control. For example, familial hypercholesterolemia, LDL cholesterol above 190 mg/dL, diabetes or significantly elevated blood pressure.”
These issues may remain despite your best efforts with lifestyle management. This isn’t a failure on your part, only a sign that genetics are very strong in this regard. Even if lifestyle changes can’t do everything, odds are good that a healthy lifestyle will mean you need less medical therapy in the long run.
“Guidelines for medication are based around your overall risk,” added Shoup. “If you have a high 10-year-risk, you may benefit from statins when combined with lifestyle changes. Exposure to higher levels of LDL cholesterol over time is also an important factor, so even younger people with healthy lifestyles could benefit from earlier medication-based treatment if their lipid levels or genetic risk is high.”
In the end, a healthy lifestyle may not be enough to keep you off statins for good, but it can ensure your need for treatment isn’t as high and help you maintain your overall health and well-being for longer.
Think of healthy lifestyle choices as the foundation of good health, where medications such as statins are more like bricks to build the walls.
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