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Coronary heart disease is the leading cause of mortality, accounting for as many as 30% of deaths worldwide. According to data published in the July 2012 issue of the Indian Heart Journal, 30 million Indians suffer from heart attacks every year—and the figure is on the rise in both rural and urban areas. The data also suggests that Indians are now suffering heart attacks at a much earlier age than their Western counterparts.

“Cardiovascular disease is like an epidemic in our population," says Vanita Arora, senior consultant and interventional cardiologist at Max Healthcare in Saket, New Delhi.

So what’s going wrong and what can we do about it?

“Indian males are predisposed to the disease because the coronary arteries (which supply blood to the heart) are, by nature, smaller and more prone to clogging. Women were initially thought to be protected from this disease until menopause (because the hormone oestrogen acts as a safeguard). However, over the last decade, more women are contracting heart disease at a younger age owing to bad lifestyle habits," says Dr Arora. “In both sexes, stress, smoking, a sedentary lifestyle, pollution and erratic eating habits are making them more susceptible to the disease at a younger age," she adds.

The cholesterol check

Cholesterol is often thought to be the villain, for too much of it can clog the arteries. Seldom do we realize, however, that this waxy, fat-like substance is found naturally in every cell in the body and that we are dependent on it for normal functioning. “Cholesterol aids in hormone synthesis, vitamin D production, cell growth and brain development," says V.V. Muthusamy, medical director, chief cardiologist and hypertension specialist at Sugapriya Hospital in Madurai, Tamil Nadu. “Seventy per cent of the cholesterol we need is synthesized in the body and we avail of the rest from food," he says.

It’s easy to see how excessive cholesterol levels can build up in the bloodstream, especially if we are exposed to too much of it from the foods we eat. “There are two types of cholesterol. HDL is often referred to as the ‘good’ cholesterol. It helps remove excess cholesterol from your body. LDL, or the ‘bad’ cholesterol, creates a build-up in your arteries. This can lead to blocked arteries, and these blocked arteries can cause a heart attack or stroke," says Dr Arora.

A blood test (usually recommended for those above 40) can show if your cholesterol levels are ideal. A total cholesterol reading of 200 mg/dl is considered desirable. However, in addition to the cholesterol reading, a standard test (called lipid profile) can measure three kinds of fat (lipids) in the body separately: These fats are HDL, LDL and triglycerides. Each value is important in helping your doctor decide whether you need a prescription of statins.

Ideally, your HDL cholesterol should be higher than 40 mg/dl (the higher the HDL cholesterol, the better it is for your body because this regulates LDL cholesterol as well). LDL should not exceed 129 mg/dl—this artery-clogging fat should be kept to a minimum. Triglycerides, the third kind of lipids, are produced when fat in the foods we eat is broken down and digested. These levels should be maintained at 150 mg/dl.

According to a report in The Telegraph, a recent, Israeli-led study of more than 31,000 patients with heart disease found that lowering cholesterol beyond a certain point made no difference in protecting them from problems like heart attacks, angina or strokes. The study was published online in the journal JAMA Internal Medicine.

The pros and cons of statins

But if any of the levels are out of sync, it is perceived as a major risk factor for heart disease, and a group of drugs called statins, which work in two ways to reduce cholesterol levels, are prescribed to prevent fat from clogging arteries and affecting the heart. For clinical trials over the years have shown that they do reduce the risk of coronary heart disease.

“First, it blocks the enzyme (called HMG-CoA reductase produced in the liver) that creates cholesterol. Reduced production lowers the amount of cholesterol available in your bloodstream. Statins reabsorb existing cholesterol as well. When your body cannot get the cholesterol it needs from circulating blood, it needs to find other sources. It does this by reabsorbing cholesterol that has built up as plaque in your arteries," says Dr Arora.

The most common side effects that many experience are aches and pains, body and muscle fatigue. Muscular fatigue is related to the dose and type of statin prescribed, says Anoop Misra, head of internal medicine and chairman at Fortis Hospital (Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology) in New Delhi.

“You may be more prone to such side effects if you take statins at an older age, have a genetic predisposition to heart disease, or if you’re female. A 2013 study, published in the Diabetes Care journal, has found that since women have a smaller body frame than men, it can possibly make them intolerant to statins. And when you’re older and more frail, your ability to tolerate statins declines even further. But, overall, these drugs have a good safety record," says Dr Misra. “Sometimes, vitamin D deficiency and low function of thyroid hormones increase the risk of muscle damage. These factors must be taken into consideration (and discussed with your physician) before starting statin therapy."

It is important to monitor and stay alert to the changes in your body after starting statins. You may experience headaches, diarrhoea, constipation, rashes, an upset stomach and joint pain, says Dr Muthusamy. “Elevations of liver enzymes are common (in patients taking a high dose of statins). Rarely, polyneuropathy (nerve weakness), affecting hands and feet, is also noted. Increased blood sugar level is often recorded in our country, leading to type 2 diabetes later. Memory loss is also noted in a few patients," he adds.

For most people, however, statins are relatively safe and will not cause any notable side effects.

Of course, your doctor is the best judge.

Statin checklist

Precautions to be taken while on medication

u Monitor your blood sugar levels

“Patients must be aware that there is a small possibility of getting diabetes if a patient (taking statins) is non-diabetic, but this is usually outweighed by the heart-protective action of statins," says Dr Misra. “The risk-benefit ratio should be considered while considering statin therapy in such persons. However, patients with diabetes who are more than 40 years old should take statins to decrease cardiovascular risk." Monitoring your blood sugar levels at least once a year is important, especially if you have a family history of diabetes.

u Get plenty of vitamin D

In recent years, studies have suggested that an increase in vitamin D can help people overcome many of the side effects of statin intake, especially muscular pain. Dr Misra advises 30-minute exposure to sunshine every day—take a walk outdoors.

u Don’t stop medication abruptly

When experiencing side effects such as muscular pain or cramps, patients tend to abruptly abandon medication. “Stopping statins suddenly may cause other complications," says Dr Arora.

If you have a strong family history of heart disease, diabetes, stroke or arterial blockage, statins may be prescribed just to keep your LDL cholesterol to the minimum. Stopping abruptly can interfere with this.

u Update your prescription

Earlier, a combination of statin drugs (one or more statins) was commonly prescribed in India. The FDA (the US’ food and drug administration) formally withdrew the approval of combinations of statins and niacin as well as statins and fibrates in 2016, because there was no indication (in clinical trials) that these combinations actually helped prevent cardiovascular disease or benefited the heart in any way, says Dr Arora.

So keep up to date with changes and discuss these with your physician regularly to settle on the right dose and keep discomfort to a minimum.

u Avoid rigorous exercise

While it’s true that exercise helps raise good cholesterol levels in the body naturally, people taking statins should avoid rigorous exercise, for it leads to an increase in muscular pain. It’s best to ease into an exercise routine gradually—and on the advice of your physician, says Dr Muthusamy.

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