Statins, Exercise and Heart Disease

with Mark Leitschuh, M.D., F.A.C.C., Cardiologist, Columbia St. Mary’s

Posted: Feb. 1, 2005

Statin therapy is one of the cornerstones in preventing coronary artery disease as well as in treating patients diagnosed with that disease, according to Mark Leitschuh, M.D., a cardiologist with Columbia St. Mary’s.

“Statins, which have been used over the past 10 years or so, are the most efficacious of drugs in lowering LDL-cholesterol (bad cholesterol) and are generally well tolerated by a majority of patients,” he said.

How statins work
The main advantage of statin drugs is lowering LDL (low-density lipoids) cholesterol levels more than other types of drugs. Statins inhibit HMG-CoA reductase, an enzyme that controls the rate of cholesterol production in the body. These drugs lower cholesterol by slowing its production and thus increasing the liver’s ability to remove the LDL-cholesterol already in the blood.

Mark Leitschuh, M.D., Cardiologist, Columbia St. Mary’s Hospital "Studies have shown that LDL levels of less than 70 result in fewer cardiac events for patients being treated aggressively."

According to the National Institutes of Health, studies using statins have reported 20 to 40 percent lower LDL-cholesterol levels in patients on these drugs.

Statins also slightly reduced triglyceride levels that were elevated, and produced a modest increase in HDL (high-density lipoprotein) cholesterol, the “good cholesterol.”

Cholesterol is a waxy substance that occurs naturally in all parts of the body. It takes only a small amount in the blood to help the body’s normal functions. But if individuals have too much of it in their bloodstream, it can lead to atherosclerosis, a condition in which fat and cholesterol are deposited in the walls of the arteries in many parts of the body, including the coronary arteries that feed into the heart.
In time, narrowing of these arteries can produce the signs and symptoms of heart disease, including angina and heart attack, which is why it’s a good idea to control your cholesterol levels.

LDL cholesterol levels
“There’s a guideline, which gets updated periodically, from the National Cholesterol Education Program that recommends how low LDL cholesterol levels should be,” Dr. Leitschuh said. “For patients with known coronary artery disease, the old guideline said LDL levels should be below 100. But now the guideline indicates that attending physicians have the option to lower the LDL of their patients to 70 or below. Studies have shown that LDL levels of less than 70 result in fewer cardiac events for patients being treated aggressively.”

If you don’t have coronary disease, the goal for your LDL count is based on risk factors you might have. “The risk factors include smoking, hypertension, diabetes, family history of coronary disease; and the higher your risk, the lower your LDL count should be,” he said.

Side effects
Statins do have side effects, according to Dr. Leitschuh. “The main ones are muscle and joint aches. And the more serious ones include inflammations of muscle cells and of the liver. That’s why these medications should be monitored by a doctor. Liver tests are usually conducted six to eight weeks after starting the statin therapy.”

Role of exercise
Exercise will help lower total cholesterol levels by a modest amount, Dr. Leitschuh said. “Exercise is moderately successful in lowering LDL levels, but more effective in raising HDL levels, which are often low in patients having coronary disease,” he explained.

“Patients with metabolic syndrome, a condition that combines obesity, hypertension and insulin resistance, will often have elevated levels of triglycerides. An exercise program is good for treating all of those conditions. It can increase insulin sensitivity, enhance weight reduction, raise HDL levels and lower triglycerides. It can also help manage blood pressure and diabetes.”

The federal government recently announced new guidelines for exercise.

“For exercise to be beneficial, they recommend that adults do 60 minutes of moderate to vigorous exercise daily, and 60 to 90 minutes daily to initiate and sustain weight loss. Exercising three to four times a week isn’t considered enough any more, although I tell patients that a walk around the block is better for them than sitting and watching TV. Doing more exercise gives one an incremental benefit.”

Dr. Leitschuh cautions individuals to check with their doctors before starting an exercise program. “If you do get your physician’s OK, be sure to start off slowly and gradually increase intensity.”

Mark Leitschuh, M.D., F.A.C.C.
North Shore Cardiology
2015 E. Newport Ave. #600
Milwaukee, WI 53211
414-961-5000

We Have Answers Do you have medical questions or need help finding a doctor? The experts at Columbia St. Mary's and Advanced Healthcare can help. Click here.