Q&A: statins vs. lifestyle to lower cholesterol; lipoprotein (a) levels + heart disease; reducing risk for Parkinson's; & preventing + treating norovirus 🤢

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In this week’s reader-submitted Q&A, we’re tackling these questions:

• Do I need a statin? Or are there natural ways to reduce LDL levels?

• Should I get my Lipoprotein (a) checked?

• How can I reduce my risk for Parkinson’s?

• How should I prevent and treat norovirus?

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Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.

Photo by Ali Hajiluyi on Unsplash

The following subscriber questions have been lightly edited for length and clarity.

QUESTION #1: STATINS VS LIFESTYLE TO LOWER CHOLESTEROL

I am 58 and I have high cholesterol numbers, even though I live a healthy active lifestyle. My NP sent me to a cardiologist who did an EKG which was normal. He suggested a CT scan to obtain a Calcium score baseline - my score was 0. The cardiologist wanted to put me on a statin for a high LDL cholesterol. I prefer to focus on living a health and active lifestyle. Once you start a statin, I am told you can never stop using it. Plus, aren’t there “natural” methods to reduce LDL and other cholesterol levels?

-Carol W

Dear Carol,

There is a lot to unpack here. First, it is not true that you can never stop using statin drugs once you start taking them. Statins are designed to reduce LDL cholesterol levels. Lifestyle modifications can lower LDL levels, too. Patients who take statins who simultaneously engage in lifestyle modifications can, in certain clinical scenarios, reduce the statin dose or discontinue it altogether. Not to mention that the decision to treat any condition with meds versus lifestyle should be a shared one between patient and doctor.

Arguably the only patients who should take statin medications for life are those with familial hypercholesterolemia (a genetic predisposition to very high cholesterol levels) and those with known existing atherosclerosis (cholesterol plaque in arteries of the heart or other organs), even if those patients are living a heart-healthy lifestyle, and even if they have normal LDL cholesterol levels.

Note that statins benefit more than our blood test results. They not only reduce LDL cholesterol levels, they also help stabilize existing arterial plaque (which doesn’t go away) in patients with known atherosclerotic heart disease.

In your case, a zero percent coronary calcium score is certainly very favorable. It suggests that you do not have “hard” cholesterol plaque in the coronary (heart) arteries. Note that a zero percent scan does not rule out the possibility of having “soft” plaque which is not yet calcified (the calcification is what makes it visible on the scan). Also note that having a high LDL cholesterol is one of the top risk factors for the development of cholesterol plaque—and, consequently, for heart attack and stroke. In other words, a zero percent calcium score does not mean you won’t eventually develop cholesterol plaque. For some people, starting a statin before cholesterol plaque is visible on a scan is appropriate—that is, for primary prevention of ASCVD. (See my answer to question #2 below about using a Lp(a) level to better risk stratify your risk below.)

So, how can you reduce cholesterol levels through lifestyle? The short answer is diet and exercise. The longer answer is this:

• Consume a diet that is rich in fruits, vegetables, whole grains, nuts, seeds, lean proteins, and healthy fats.

• Reduce your intake of saturated/trans fats, refined sugars, and processed foods. Foods that are notoriously high in cholesterol are typically animal-based products such as organ meats, poultry with skin, fried foods prepared with animal fats, and processed meats such as sausages, bacon, and deli meats, as well as fatty cuts of beef, pork, and lamb. Shellfish (e.g., shrimp, lobster, and crab) and full-fat dairy products (e.g., butter, cream, whole milk, and cheese are also rich sources of cholesterol.

• Engage in regular physical activity, aiming for at least 150 minutes of moderate-intensity aerobic exercise per week.

• Achieve and maintain a healthy weight with the combination of diet, exercise, little-to-no alcohol, and medication (e.g. GLP1s such as Ozempic) as needed.

Heart health is one of my favorite topics. So please let me know if you need more info in the comments below!

QUESTION #2: LIPOPROTEIN (A) LEVELS AND HEART DISEASE

Should I get my Lipoprotein (a) checked, along with the usual cholesterol levels you mentioned in last week’s Q/A? One of the comments mentioned lipoprotein (a) as something to consider as a cause for cholesterol plaque. Can you comment on that?

-Nora K

Dear Nora,