Don't Focus on Statins Alone

Tougher federal guidelines for blood cholesterol levels could lead millions more Americans to take cholesterol-lowering statin drugs. But whether your cholesterol is already too high or you just want to keep it from rising, experts say food and fitness remain key allies in defending against heart disease and stroke.

That message tends to get lost in the praise for statins. While their ability to lower cholesterol is impressive, what many consumers overlook is that statins are meant to be used along with a healthy diet and more physical activity.

There's no question that just making diet changes compared with taking statins to control blood cholesterol "looks like David versus Goliath," said Neil Stone, professor of cardiology at Northwestern University School of Medicine in Chicago and a member of the committee that wrote the cholesterol guidelines published last week.

When they're first prescribed, statins can lower blood cholesterol levels by 25 to 45 percent. That's four to eight times better than diet and lifestyle changes. So an increasingly common tactic is to simply prescribe higher doses of statins to control blood cholesterol, since popping a pill is often easier than changing diet or getting more physical activity.

Yet what most people don't realize, Stone said, is that the benefits of taking statins don't multiply at the same rate when doses are cranked up. "Every time you double the dose of statins, you only get an extra 6 to 8 percent lowering of cholesterol," he said. Higher doses cost more and have more possible complications.

By comparison, eating a healthy diet, low in fat and cholesterol, and getting more physical activity "also lowers blood cholesterol 6 to 8 percent," Stone said. "That saves you money and potential side effects...Plus, if you don't follow as good a diet as possible, you could diminish the effectiveness of statins such that you don't reach the newer blood cholesterol goals."

And what about those whose blood cholesterol levels are normal? The best bet, Stone and other experts said, is to do something that will sound familiar to Lean Plate Club members: Use healthy foods and regular physical activity as a defense against future blood cholesterol problems.

Here are some of the tactics that experts say can help lower blood cholesterol or just help maintain normal blood cholesterol:

• Aim for a healthier weight. Losing even a few pounds if you're overweight is one of the most powerful ways to reduce blood cholesterol levels. "People can lose just eight to 10 pounds and have a dramatic improvement in their blood pressure and blood cholesterol levels, even if they don't reach their target weight, even if they still need to lose 80 pounds more," said Judith Hsia, director of the Lipids Research Clinic at George Washington University. And as Hsia noted, "it doesn't cost money to eat less."

• Limit unhealthy fat. That means saturated fat, trans fatty acids and cholesterol found in marbled meat, poultry with the skin, fried food, full-fat dairy products and commercially prepared baked goods. Federal guidelines say to keep saturated fat at 10 percent or less of total calories; 7 percent or less for people with elevated blood cholesterol. The National Academy of Sciences has advised keeping trans fat as low as possible, while current advice for cholesterol from the American Heart Association is to limit it to 300 milligrams per day -- about that found in one egg yolk.