I recently went through a heart Cath and they found medium ostial disease of the D1. A long section of diffuse mild to moderate disease in the LAD itself and moderate disease in 2 other arteries. My flow factor in my LAD is borderline at 0.81 so close to flow limiting but not quite enough for a bypass (diffuse disease) or stent (calcium score 700 on the LAD so difficult) - anyway they didn’t stent me and have put me on long term statins and advised me to change my lifestyle. I’ve started on the Esselstyn a month ago. My cholesterol is already down to 4.1 from nearly 7. I am asymptomatic. My stress test is in 4 months 😞
My question is, can statins and lifestyle changes hold things where they are long term or should I be ready for a procedure in the next 5,10 years obviously hoping there are no events in this time. I guess to clarify my question better, can people with moderate / extensive CAD stabilise enough with statins and lifestyle changes in the really long term ???
I would really appreciate some help with this question if someone is able to give me a better understanding or is going through similar. I’m trying to work out where I really stand and what is realistically possible.
I know statins have been around for some 30 years now but cannot find any long terms studies that would give me a better understanding. I have kids so “sticking around” is very much on my mind.
I send you all my love and prayers
Mark
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my husband is 22 years on from angina attack leading to four stents. His lifestyle and diet were fairly good at the time but I ensured they were better.
His chol is well under control with statins.
I seem to remember, a few months ago, reading of long term studies concluding that, overall, statins were a good thing for the population.
But I think you are seeking more individual advice?
I really appreciate your reply and I’m so happy to hear that all is well with your husband and 22 years on and he is doing well. Clearly you’re an amazing wife and have made sure that he keeps things as healthy as possible. That really does help and I believe statins are a lifesaver
Thanks so much for your reply and I wish you both continued heath and strength
Bravo for trying the Esselstyn diet. I did it for 6 weeks and it cut my LDL cholesterol by 1/3 (and I was already on statins). But I couldn't do it long term, way, way too much effort, especially because no one else in my family wants to eat like that.
I've taken away some good things from it, however, mostly with regard to eating more veg/fruit, no processed foods and cutting way down on fat. But note that Esselstyn says the total fat threshold at which you'll see a change is just 10%. That's about a tablespoon of olive oil a day...I have friend who has been on Esselstyn for 10 years and has kept his LDL way down in that time. But he's a spartan!
As for statins, I can only give you the example of my brother, who is my age (mid 50s) and has a similar health profile. He went on statins in his mid 30s because of high LDL, despite eating a decent diet and being otherwise quite fit. I did not because my LDL was never in the red flag zone. I have had 2 heart attacks due to CAD and 4 stents. He is still well within the healthy range for plaque (he has some, but nothing that would warrant a stent or other intervention).
So, for him, being on statins for nearly 20 years has probably prevented a heart attack.
Edit to add: I had 2 stents in my LAD and was told all is well. 8 months later I had another HA due to plaque breaking off in my circumflex artery. So there are no guarantees either way.
My latest exercise stress test and ECG were all good. I have some damage to my heart, some blockage in my RCA, and I'll probably never be able to exercise flat out again, but at the moment I think my odds are good that I'll get to my threescore and 10, as they say (though 80 would be better!). I'm on the highest dose of statins (80 mg atorvastatin + 10 mg ezetimibe) plus bisoprolol and plavix.
Thank You sooooo much for your reply. It really does put things in perspective. I think statins really are a lifesaver. Ahhhh you’re so young, same as me. It’s really not fair but you are clearly on top of things now with a good ECG and stress test. I’m so sorry to hear what you have been through. You’re clearly a Spartan yourself.
As for making 80, I have the same thoughts but there are lots of new things on the horizon and techniques are improving all the time. I guess all we can do is follow the science and keep doing as many of the right things as we can. I’m eating black bean spaghetti and similar which I’m getting on Amazon and one you stick a nice tomato sauce on top, it tastes like any of the high fat stuff I used to eat …
I wish you continued good health and thanks again so much for replying to my message. It’s given me a lot of hope. I’m also here foryou to talk anytime. Will keep an eye on your posts
hi MarkI have very similar diffused plaque to 7cm of LAD tried to put stent in but said he couldn't do it as no suitable landing place,referred to surgeon who wasn't sure if it warrants bypass asked me to do the meds and healthy lifestyle (diet)for 3mths then review,which I did and most of the time I feel very well but not quite the person I was before all this happened to me,when I saw the surgeon again he asked me if I wanted to go on surgery waiting list,so I elected for surgery this was 6 mths ago I have since seen senior consultant who thinks they should maybe try stents again and am in for echo stress test next week ,see what that shows up .my back ground very fit ran all my life probably drank to much and had poor diet, as they say you can't excersise away a bad diet I can confirm that's true, my cholesterol ha come down to 3 from 5.4 try to follow whole food diet best I can and cut out as much upf as I can. try looking at 2 books ,how not to die .and ultra processed people .both eye openers and very educational ,any questions please ask my treatment has been on going for 2 yrs and I do actually feel health wise in a better ace now than 12 mths ago.Regards Terry .
Hi Terry. Thanks for connecting and thanks also for the follow. I am now following you back.
I don’t feel the like person I did either before all of this. I keep looking at pictures of my calcium (nearly 1000) and it looks like a Christmas tree. Then I obsess about having 4 arteries blocked. It takes a hell of a lot out of you mentally. But there really is hope. My father had a bypass in his late 60’s and live until he was 92 and we are in a different world now technology and skill wise. Can’t say stents or bypass but they’re both very safe these days and you sound like you’re in good shape despite all.
Yes I’ve got my cholesterol down with the Esselstyn diet from 6.4 to 4.1 - there is also evidence that once the LDL is under about 1.5 it stops progression and if you can get it before 1 it can regress up to 24%. There are also studies that statins can not just stabilise but also reverse.
Do you know the % blockage and/or FFR in your LAD ? Are you asymptomatic ? Are there any other arteries with any narrowings?
my plan of action is to try to stay as sane as positive as possible and stick with the esselstyn diet. I do actually believe it has brought people back from the worst possible situations, much worse that ours.
Please do let me know what happens next week. And feel free to send me a private message anytime.
Also, note that the purpose of statins is two-fold. Reduction in bad cholesterol or LDL, but also the stabilisation of the plaque. The latter is just as important.
100% Correct. Only things that really concerns me is that statins calcify plaque, good thing, but when you already have a 700 calcium score on the LAD, that will just make the arteries harder - I’m not sure how bad that is but it definitely worries me…. Hope you’re doing well 🙏
Life style changes yes overweight, high blood sugar go very closely with CAD,. Statins not so much so the absolute difference in life expectancy using statins against not using them is about 5 days for most people.
Dont agree with this. I am an identical twin. Both have the same diet and lifestyle. Not overweight - however, he started his statins after full heart check-up after he complained about chestpains. He has calcification, but insignificant. He was put on the lowest dose of statins. He warned me about this and advised me to do the same as we have the same genes. I pushed back and said that I will manage via diet.
Fast forward 6yrs - I have had a heart check up after heart palpitations. Guess what, 50% LAD stenosis.
I wish I had listened to him, given our family history - but that is water under the bridge now. Have to manage and move forward. To claim that statins do nothing is just plain wrong. Statins have been around for a long time and is one of the most studied drugs.
I agree with you 100%. statins are the most studied drug in the world and we know that they stabilise soft plaque and reduce inflammation. I’m certainly not going to stop taking them. I have 5 affected arteries including a long section of diffuse disease in the LAD. I have to follow the science with this one …..
Observation you may be identical twins but does that mean you have 100% identical DNA? I don't know the answer but I doubt it. Diet are you telling me that you have 100% the same diet every meal day after day? The problem with diet is that in todays world even two food items that appear to be the same often are not.
Finally statins and studies into their effects who pays for the studies? I am an old cynical man and their is a lot money in pharmaceuticals and many vested interest in ensuring that that continues to be the case.
I don’t disagree with you. Of course Pharma is a business and a lot of money is spent by people on medications that they don’t need. All I’m saying is that when my internal cardiologist tells me to take a statin so he doesn’t need to operate on me, its not good for business, so I have to take that as a genuine attempt to help me. Yes we are all different, I agree with you 100% and There is no one correct strategy for all. Horses for courses. Hopefully statins and the right diet Etc will keep me off the operating table. It’s the gamble I’m taking because nobody has given me a viable. Many many large studies suggest help people in similar situations to mine that are borderline for operations …. I understand that there are conflicts of interest with a lot of these, but hopefully this choice will extend my life a little. Time will tell I guess
One you have CAD Statins have been proved to calcify dangerous soft plaque and reduce inflammation. Perhaps in people with no risk factors your statement may stack up. I’d be interested in a link to the 5 day life expectancy of you have one ?
As ever when you need to lay your hands on a specific reference it seems to have disappeared , however the real issue is about how risk is portrayed, absolute v Relative this link explains it quite well. Expressed as a relative number it looks magic, however expressed as an Absolute not so much so. This sleight of hand appears to be widely used in the Pharma world.
It’s all good. Again I think it’s about horses for courses. I need to take my chances with statins because nobody has given me a viable alternative for my situation
I am actively trying to get off statins and i spoke about the benefit of statins if you hsve a diet low in ultra processed food. I dont take seed oil ever and only cook with Oilive oil never eat take aways and cook from scratch.
All drugs have side effects and i certainly dont want to be on drugs if i do not need to.
I do not drink alchohol and take only decaf coffee.
I asked my surgeon if he could show me the evidence on what the benifit i get taking a statin and he said he couldnt.
My heart disease came from poor family history but i excercise vigoursly every day.
I did say when father time catches up and i cant ride my bike 50kms a day then i will take statins.
In the short term i will get a CAC done in Cyprus privately every year to check on my arteries in my heart.
The best predictor for heart disease is triglycerides to hdl ratio and mines sits at 0.5. This is cutting out all sugars.
LDL is what is always stated as been the driver for heart disease but in fact it should be high triglycerides. But there isnt a drug to lower trigs other than lifestyle changes so doctors dont really push that narrative.
There are drugs that lower Triglycerides. They’re called Fibrates.. Unfortunately I do have soft plaque in 5 arteries including the LAD so I take my statins because they do calcify soft plaque, reduce inflammation and HA and stroke risk. But I wouldn’t take them unless I needed them. We are all different.
I have got my cholesterol down from 6.6 to 3.1 in 7 weeks on a wholefood, plant based, oil free diet. And also lost 12kg which will hopefully help with my triglycerides which you correctly state are a major and often ignored risk factor.
Best wishes 🙏
Why would you want to take drugs to lower tryglycerides when this can be achieved by dropping achohol, sugar and ultra processed foods. My trigs are 0.52 and my remnant cholestoral is 0.31.
I also paid for advanced lipid paneles that show i have extremly low levels of small dense ldl.
Every drug has side effect that can impact overall health. I have heard the benefits that statins have on lowering LDL and hardening plaque but not on inflamation.
If statins were the miracle cure then why is patients with CAD on the rise and why the overall health benefit by taking statins measured in days rather than years, if the patient reduces all the other risk factors like weight, smoking, high blood pressure, achohol, sugars, seed oils etc they will improve longevity.
I had heart disease and my LDL was 3.0 so based on the LDL hypothesis i should not have had plaquing of my arteries.
Dave. Please allow me to clear up a few misconceptions here. Firstly I don’t WANT to take statins or any other drug but unfortunately my body does not work the same was as yours does. I don’t smoke, I don’t drink, I don’t eat sugar and I’m on a plant based, wholefood diet. In the first 3 weeks my triglycerides were still at 3.5. I was following your protocol and more but it wasn’t working for me. We are all different. Our bodies work differently. Genetics work differently. I only have a few options regarding lowering my triglycerides and one of them is statins. And it’s not about a “miracle cure” - it’s one of the few things that has been proven to me and time again to REDUCE inflammation, lower HA and stroke risk and stabilise soft plaque. My LDL is down from 3.5 to 0.86 - I’m sure that statins did play a part in that as well as my radical lifestyle changes.
Here is proof that statins reduce inflammation. I honestly think you need to accept that there is no “one fits all” solution when dishing out health advice. Your protocol opens not work for me and unfortunately so I have to look for other options
Thanks for the link Mark. I have an appointment to see my Cardiologist. I have low Apolipoprotein E which is needed for good brain health. I took Randox Everyman test while on 20mg of Atoravastatin. After a few weeks off statins i did a finger prick nhs test that showed my total cholestoral to be still under 5. So i do npt have high cholestoral when not taking statins.
In another 4 months i will take the randox blood tests again and compare the readings and see if my Alipoprotein E has increased.
My major fear is with the linkage of dementia and liver health for the continous use of statins. I dont like to be categorised as a general population. As you say we are very different.
My heart disease came from poor life style in you youth and having a poor diet. My heart itself is very health and unscathed. I just never want to go through another heart op. I know i am very lucky and i caught my severe disease before i had a heart attack which would of damaged my heart.
I dod lose siblings to this awful disease.
I watched a podcast that showed no matter your age lifestyle can jave positive rewards.
I understand your position 100%. I know about the concerns regarding dementia and liver disease (I have NAFLD too), and there are concerns regarding type 2 diabetes as I’m sure you know too. You have made an judgement call and you believe that you are better off without Statins. You seem to be doing just fine without them. You’ve done your homework.
I didn’t know about Alipoprotein E by the way. I need to check that out too. Thank You
Yes thank God they caught this before you had a HA. Like you I also didn’t look after myself until very recently. You’ve clearly been given a second chance and it looks like you’re on top of things. It seems I may have been too but I am honestly not thrilled about taking statins because I already have a very high calcium score and this will only increase. But right now I think I need to take my chances. My diagnosis is very recent and I have soft plaque in 5 arteries including the LAD so if the statins calcify this plaque in the next year or two, perhaps I can get off them.
Im sorry for your loss, I lost my Dad and also lost a lot of family …. Some younger than me. A cousin went with his wife and 2 young kids on holiday a couple of years ago. Never smoked, healthy weight etc etc and dropped dead by the swimming pool at 36. He would have had no idea he had issues.
I’ll look out for your randox results in a few months. Please let me know how you’re getting on. I have my stress test in November/December ….
If you can tolerate - I think it is worth a shot. Someone mentioned above, no one likes taking statins or any medicine for that matter that is certainly true. People with heart issues take a cocktail of medicine, I am sure at times they are fed-up - but they realise it is a daily routine and it keeps them going.
I was a sceptic for too long about statins and as the damage had been done, I want to rectify the situation. Statins on its own wont be the miracle for me, it will be part of the overall package that includes healthy lifestyle too. I am not a Dr, so not close to the physiology of the body - but acknowledge that it is complex and many factors like genes, inflammation, cholesterol,bp, diabetic,... can all have an impact on CAD and in different ways for each individual.
But have read many papers and studies concluding the benefits of statins and these seem pretty well researched with a decent sample size. For all the people that are so anti statins, show me the same number of studies telling the opposite.
In the long run we will be dead anyway, but worth living a quality life for the max amount possible not just for yourself but more importantly for the ones close to you.
So, each to their own - whatever rocks your boat tbh.
My grandad died in his late 40s after a sudden HA. Dad had HA at 36, but managed to strecth it to 67 with medicine. Didnt have another HA again, but eventually passed away from heart failure. He was diabetic and not that fit and I am sure if he had worked on a healthier lifestyle he would have lived another 10yrs.
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