Everything You Need to Know About Statins - Dr. Kulmeet Kundlas

Episode Transcript

(00:00):
.95Hello world, this is Dr. 2 00:00:02,599.95 --> 00:00:09,260 Kulmeet Kandlas and welcome to this podcast and we are continuing our discussion.
About cholesterol and cholesterol related issues from last YouTube live session and podcast.
.001There were a lot of questions regarding statins, so we are now doing a dedicated session about Everything about statins as a primary care physician. 5 00:00:29,750.001 --> 00:00:39,600.001 I don't believe there is any medication Which I have seen provokes more emotions than, uh, uh, statins. 6 00:00:40,200.001 --> 00:00:41,700.001 Everybody has opinion. 7 00:00:41,850.001 --> 00:00:48,280 There is a lot of science, ton of pseudoscience about statins.

(00:48):
.999In this next few minutes, 10 15 minutes, we have it together.
My goal here is to ensure that you get the facts and have a knowledge base.
to make a decision where you could make informed decisions for yourself.

(01:09):
.999Let's start with the fundamental question, what is statins? Statins is a medication which stops the production of cholesterol by your liver. 12 00:01:21,429.999 --> 00:01:25,819.999 When you get a blood test, and you get a reading about the cholesterol. 13 00:01:26,419.999 --> 00:01:31,699.999 80 percent of the cholesterol which you measure comes from what is made by the liver. 14 00:01:32,299.999 --> 00:01:35,359.999 Your diet is contributing only 20%. 15 00:01:35,959.999 --> 00:01:40,220 So liver is the main player regarding cholesterol.

(01:40):
So once we block this medication in the cholesterol synthesis, your cholesterol level goes down.
.001If you want to have a little bit of broader picture, so that you will have a broader context, let's understand the cholesterol in less than three minutes to build a case to understand how these medications are related and what are the natural way we could do that and few other things. 18 00:02:10,210.001 --> 00:02:13,560.001 Cholesterol is very, very important. 19 00:02:14,50.001 --> 00:02:24,100.001 It has a bad name because whenever the arteries get clogged up in the plaque, we have LDL oxidized LDL cholesterol. 20 00:02:24,700.001 --> 00:02:30,910 That is where, when we do the things wrong and the cholesterol is more than what we need to.

(02:31):
Every cell of your body is made up of, the cell membrane is made up of cholesterol.
It is required for hormones.
.999It is required for vitamin D.
This means you require it for hormones.
.999So it's very, very important. 26 00:02:49,369.999 --> 00:02:53,109.999 80 percent of the cholesterol which is circulating comes from liver. 27 00:02:53,519.999 --> 00:02:55,169.999 20 percent comes from eating. 28 00:02:55,769.999 --> 00:03:00,739.999 This discussion is not about how the diet affects your cholesterol. 29 00:03:00,749.999 --> 00:03:03,739.999 We have another video you could check at our playlist. 30 00:03:04,339.999 --> 00:03:10,849.999 But today the goal here is about the liver, statins and the medications. 31 00:03:11,449.999 --> 00:03:24,259.999 So once liver produces cholesterol, that gets tagged to lipoproteins because of, uh, cholesterol is a fat, which is a water insoluble and blood is water. 32 00:03:24,859.999 --> 00:03:29,839.999 So it tags it to lipoprotein, which is lipoprotein e. 33 00:03:30,294.999 --> 00:03:36,134.999 And then it gets circulated in the body and then it goes to be used where it needs to be used. 34 00:03:36,734.999 --> 00:03:45,314.999 The relationship, how much liver is going to make and how much we are going to absorb from the gut, depends on the needs. 35 00:03:45,914.999 --> 00:03:49,374.999 But there are some physiological hijacks which can happen. 36 00:03:49,974.999 --> 00:03:57,584.999 If you are eating only The fats and the cholesterol body knows what to do. 37 00:03:58,184.999 --> 00:04:02,514.999 If body doesn't need cholesterol, it will decrease the production by the liver. 38 00:04:03,4.999 --> 00:04:03,984.998 And also. 39 00:04:04,369.999 --> 00:04:07,319.999 it will shut down the absorption from the gut. 40 00:04:07,919.999 --> 00:04:13,189.999 If body is deficient in cholesterol, it will mobilize all the sources and use it. 41 00:04:13,789.999 --> 00:04:20,429.998 What we do here is we hijack our physiology, our homeostatic mechanism. 42 00:04:21,29.998 --> 00:04:32,969.998 If you are eating simple carbohydrates, it is amazing to know that 80% You know, many, many people come from processed and ultra processed food. 43 00:04:33,349.998 --> 00:04:43,109.998 But on an average, as a nation, as a United States, about 60 percent of our calories come from processed and ultra processed food. 44 00:04:43,709.998 --> 00:04:58,9.998 These ultra processed foods When they get into gut, they spike insulin and insulin changes the homeostatic mechanism in the liver and it pushes production of more cholesterol. 45 00:04:58,609.998 --> 00:05:02,779.998 So that's how your simple carbohydrates push your cholesterol high. 46 00:05:03,379.998 --> 00:05:04,969.999 Then if you are eating. 47 00:05:05,344.999 --> 00:05:11,724.999 Too much of saturated fats and the trans fats transfer, just keep it simple. 48 00:05:11,784.999 --> 00:05:14,454.998 Anything which comes in a package has a transfer. 49 00:05:15,54.998 --> 00:05:16,574.997 Transfer has an advantage. 50 00:05:16,644.998 --> 00:05:18,264.998 It has a longer shelf life. 51 00:05:18,484.997 --> 00:05:19,544.997 It tastes better. 52 00:05:19,714.998 --> 00:05:21,484.998 They have hijacked our taste system. 53 00:05:21,514.998 --> 00:05:25,954.998 It has a salt and they will add sugar to make it more palatable. 54 00:05:26,554.998 --> 00:05:29,934.998 Those saturated fats and the trans fats. 55 00:05:30,314.998 --> 00:05:37,704.998 They also hijack chemistry in the liver and lead to more production of bad cholesterol or LDL cholesterol. 56 00:05:38,304.998 --> 00:05:51,379.998 The difference is the proponent of the saturated fats like butter, margarine, they will tell you that Not only your bad cholesterol goes up and good cholesterol goes up. 57 00:05:51,469.998 --> 00:05:57,229.997 That is a true statement, but how much it goes It depends on a lot of other factors. 58 00:05:57,239.998 --> 00:06:19,629.997 So it's not as simple as far so your diet needs to be very little trans fats And very little saturated fats, what kind of fats you could eat is monounsaturated or polyunsaturated fats, which are in avocado oil, olive oil and walnuts and all this thing and fish. 59 00:06:20,229.997 --> 00:06:24,139.996 So with, so when the cholesterol two sources, liver. 60 00:06:24,584.997 --> 00:06:25,174.997 and gut. 61 00:06:25,774.997 --> 00:06:37,194.997 Then what, if we want to control the level of cholesterol in the blood, so what are the places we could act? One is, stop the production of cholesterol in the liver. 62 00:06:37,264.997 --> 00:06:38,484.996 That's mechanism one. 63 00:06:39,84.996 --> 00:06:44,814.995 And the medication which you work over there is statins, which is, we are going to be discussing today. 64 00:06:45,414.995 --> 00:06:46,494.995 They are very effective. 65 00:06:46,939.996 --> 00:06:53,739.996 They can lower your bad cholesterol almost by 50 to 60%, depending on which study you look at it. 66 00:06:54,339.996 --> 00:07:03,459.995 Second, in the gut, when the cholesterol is, we could give you medication that your cholesterol doesn't get absorbed. 67 00:07:03,779.995 --> 00:07:06,899.996 You might have heard the name of medication, zetamide. 68 00:07:07,499.996 --> 00:07:15,779.996 But it comes with a trade name, Zetia, that is the one which make your, that your cholesterol doesn't get absorbed in the gut. 69 00:07:16,379.996 --> 00:07:19,259.997 Then let's say in the gut, there are bile salts. 70 00:07:19,859.997 --> 00:07:27,799.998 The, our liver uses cholesterol to produce bile salt and bile salts are needed to absorb our fat. 71 00:07:27,800.098 --> 00:07:37,574.998 So if there is bile salt blocker medication, which, where we purge a lot of These bile salts so that they don't get reabsorbed in the gut. 72 00:07:37,854.998 --> 00:07:41,214.998 So you push a lot of bile salts out in the feces. 73 00:07:41,624.998 --> 00:07:46,14.998 That, that way your body has to use a lot of cholesterol to make it. 74 00:07:46,394.998 --> 00:07:50,344.998 And that will also lead to lowering of your cholesterol. 75 00:07:50,474.998 --> 00:07:51,704.997 So three places. 76 00:07:52,64.998 --> 00:07:52,654.998 Liver. 77 00:07:53,254.998 --> 00:07:59,384.998 Don't let the cholesterol absorb in the gut and then purge it out with the, the bile cell blocker. 78 00:07:59,984.998 --> 00:08:20,434.999 Then other thing which you could do here is there are medications which work, continue to work in the liver on the mechanism beyond the bampydoic acid is another medication which also works a step which is behind statin that that's used to block it. 79 00:08:21,34.999 --> 00:08:28,374.999 Then omega 3 fatty acids, which are in fish and the fibrates, they bring your triglycerides down. 80 00:08:28,854.999 --> 00:08:34,634.999 So the cycle is your liver and the gut are the sources of the cholesterol. 81 00:08:35,224.999 --> 00:08:50,964.999 It gets absorbed, then it's used by the body, extra cholesterol, or get brought back to the liver by the good cholesterol, dumped into your gut, and you, in the form of balsal, and this cycle keeps on going. 82 00:08:51,564.999 --> 00:08:58,504.998 Now, why statins, and what, what is the state of the affair? Let's all be honest. 83 00:08:59,104.998 --> 00:09:03,354.998 As a patient, it's my experience for last 27 years. 84 00:09:03,684.998 --> 00:09:08,24.998 And if you include residency, housemanship, It's for 35 years. 85 00:09:08,624.998 --> 00:09:20,464.998 I have never found anybody who is so good that once they have medical problem and they are given the recommendations and they will stop it. 86 00:09:21,64.998 --> 00:09:33,604.999 We fall, fall to lowest common denominator and our cholesterol is the only thing this cholesterol medication or these statin medications are the only one. 87 00:09:34,184.999 --> 00:09:35,224.999 If you take it. 88 00:09:35,824.999 --> 00:09:43,39.899 Predictably lowers your cholesterol, it gets cut into half within a couple of days and your risk goes down. 89 00:09:43,639.899 --> 00:09:52,209.899 If you are a diabetic or have already heart attack or a stroke, this medication is a lifesaver. 90 00:09:52,789.899 --> 00:10:01,319.899 That because when we know for effect, once you have a major event, you feel you are motivated and you're gonna do everything. 91 00:10:01,919.899 --> 00:10:11,239.899 But the statistics are only 5% or less are the people who could make a life sustaining change. 92 00:10:11,839.899 --> 00:10:15,109.899 And look at the thing from the medical professional side. 93 00:10:15,709.899 --> 00:10:25,749.899 When I'm looking at you, I know for a fact, no matter how much motivated you are today at the end of three months, you're going to be exactly what you are. 94 00:10:26,199.899 --> 00:10:28,119.898 So we come up with the. 95 00:10:28,719.898 --> 00:10:37,509.898 medications and the processes which we know that will impact and lower your risk for future heart attack. 96 00:10:38,109.898 --> 00:10:48,149.897 Statins lower the risk of heart attack by almost 25%, stroke by 15%, and all cause mortality by 9%. 97 00:10:48,689.897 --> 00:10:50,439.898 There is a lot of negative. 98 00:10:50,974.898 --> 00:10:55,174.898 information which I am intended to debunk and explain. 99 00:10:55,704.898 --> 00:11:01,944.898 But let's stay with me, why the cholesterol medications are important. 100 00:11:02,544.898 --> 00:11:07,634.898 The plaque which blocks your artery is giving you a heart attack and stroke. 101 00:11:08,234.898 --> 00:11:11,654.899 It's not as simple as with this thing that it's only cholesterol. 102 00:11:11,654.899 --> 00:11:14,604.899 It has a lot of connotations and a lot of process. 103 00:11:15,174.899 --> 00:11:20,689.899 But one out of them, We could predictably control HD cholesterol. 104 00:11:21,29.899 --> 00:11:31,449.899 So that's why there is a lot of push by all the agencies, regulatory agencies, and the evidence based medicine to lower your cholesterol to a level. 105 00:11:32,49.899 --> 00:11:39,389.898 State of fear is In the United States, what we consider normal is abnormal in the rest of the world. 106 00:11:39,419.898 --> 00:11:47,279.898 Because our cholesterol as a nation is very high, because of a rich diet which we could afford and consume. 107 00:11:47,609.898 --> 00:11:49,149.898 Our normal is very high. 108 00:11:49,749.898 --> 00:11:56,549.898 So once these guidelines are coming in, they are already wrong as compared to Europeans and Germans and other nations. 109 00:11:57,79.898 --> 00:12:01,79.898 What they consider normal will be abnormal everywhere. 110 00:12:01,449.898 --> 00:12:03,739.898 So our normal is also very high. 111 00:12:04,339.898 --> 00:12:24,729.897 So if you are a diabetic, or you have a heart attack or a stroke, or you have a very strong family history of heart disease, meaning you have a male in the first degree relative, less than 50, and a female less than 60 had one of these events, heart attack, stroke, or death, you are at high risk for developing it. 112 00:12:25,79.898 --> 00:12:29,759.898 And if that is happening, then your cholesterol needs to come down. 113 00:12:30,359.898 --> 00:12:40,219.898 Unfortunately, people who have a cholesterol problem, invariably they are a smoker, they are overweight, they will have type 2 diabetes mellitus and high blood pressure. 114 00:12:40,819.898 --> 00:12:47,459.898 The success rate for controlling blood pressure in the United States is very dismal, only 30%. 115 00:12:48,59.898 --> 00:12:51,179.898 Not more than 50 percent of the people are able to control it. 116 00:12:51,689.898 --> 00:12:54,329.898 So we are controlling the controllables. 117 00:12:54,389.898 --> 00:12:58,179.897 That's where a lot of push comes in. 118 00:12:58,279.898 --> 00:13:00,529.898 We, because a lot of evidence comes in. 119 00:13:01,59.898 --> 00:13:06,569.898 And we know that with one pill we could lower your risk, which I just now alluded to you. 120 00:13:06,679.898 --> 00:13:10,109.898 So statins are lifesaver. 121 00:13:10,709.898 --> 00:13:14,559.898 Now, Let's see how other parts of it. 122 00:13:14,729.898 --> 00:13:29,809.898 Next question, which we have is who should consider taking statins? Anybody who has the risk factors, the common risk factors are smoking, high blood pressure, high diabetes, and high cholesterol, and family history. 123 00:13:30,409.898 --> 00:13:34,569.898 If you have any of these, you need to consider taking cholesterol. 124 00:13:35,169.898 --> 00:13:47,389.898 Anybody whose total cholesterol is more than 240 It is abnormal and anybody whose LDL cholesterol with these condition is more than 100. 125 00:13:47,719.898 --> 00:13:48,469.898 100. 126 00:13:49,9.898 --> 00:13:49,939.898 It's abnormal. 127 00:13:50,539.898 --> 00:13:58,609.898 And unfortunately, when you have this disease issue, good cholesterol, which we want to be as high as humanly possible, it's always low. 128 00:13:58,609.898 --> 00:14:03,199.898 So the ratio of between bad, good and bad is always altered. 129 00:14:03,799.898 --> 00:14:08,199.898 Everybody who has a risk factor should be on cholesterol medication. 130 00:14:08,799.898 --> 00:14:15,209.898 What are the benefits? The next question is what are the benefits of statins? They prevent heart attack. 131 00:14:15,579.898 --> 00:14:16,829.898 They prevent stroke. 132 00:14:17,49.898 --> 00:14:18,229.898 They make you live long. 133 00:14:18,829.898 --> 00:14:36,114.898 And I, there is not another medication in its entirety which can reduce your absolute risk and relative risk of these three deadly things, heart attack, stroke, and death, to such a good level than These statins can do that. 134 00:14:36,714.898 --> 00:14:37,744.898 Side effects. 135 00:14:38,244.898 --> 00:14:42,464.898 Let's talk about that because there is, that is where a lot of hype is. 136 00:14:43,64.898 --> 00:14:49,934.898 Yes, about 5 6 percent of the people do have some muscle pains. 137 00:14:50,534.898 --> 00:15:01,374.899 In 35 years in medicine, I have never come across anybody who has muscle pains which are permanent. 138 00:15:01,974.899 --> 00:15:14,644.899 If you are one of the few unlucky ones who have real muscle inflammation, we call myositis or in extreme cases we call rhabdomyosis, you develop from this medication. 139 00:15:15,114.899 --> 00:15:18,874.899 It is 100 percent reversible and you don't have to take the medication. 140 00:15:19,414.899 --> 00:15:25,724.899 But we get so much pushback that before we even take the first pill. 141 00:15:26,124.899 --> 00:15:33,804.899 They don't, they want to have a discussion, which we are happy to do that, but they don't want to even try it because of the fear. 142 00:15:34,344.899 --> 00:15:44,774.899 And they will come up with all these silly Explanations of why they don't want to take it or why they know somebody who had a bad experience. 143 00:15:44,844.899 --> 00:15:51,784.898 If anybody in, you know, had a bad experience with the statin, that doesn't mean you will have the bad experience. 144 00:15:51,824.899 --> 00:15:56,364.899 That's something you need to definitely keep in mind. 145 00:15:56,374.898 --> 00:15:58,664.899 That, that's not a guarantee you will get it. 146 00:15:58,724.899 --> 00:16:01,234.899 It's, the risk is but 5 to 10 percent. 147 00:16:01,564.899 --> 00:16:05,44.899 And it's 100 percent reversible, no permanent damage if it happens. 148 00:16:05,644.899 --> 00:16:12,539.899 Some people who Take the statin could have a little bit of, uh, elevation of the liver function test. 149 00:16:13,139.899 --> 00:16:22,129.899 There is no case, to my knowledge, where liver function have gotten so bad that they are left with permanent liver problem. 150 00:16:22,539.899 --> 00:16:25,949.9 So, we've covered muscle pains, we've covered liver pain. 151 00:16:26,549.9 --> 00:16:32,174.901 Then, other biggest criticism comes in is Statins and diabetes mellitus. 152 00:16:32,774.901 --> 00:16:35,634.901 You have no idea how many people fight with me. 153 00:16:35,724.901 --> 00:16:40,964.901 They already have diabetes and they don't want to take the cholesterol medication. 154 00:16:41,564.901 --> 00:17:01,869.901 The truth is if you're diabetic and if your cholesterol is high your realistic chances of having these such horrible complications is so high that It lowers your absolute risk of heart attack, stroke, and death by 25%, 14%, and 9%. 155 00:17:02,469.901 --> 00:17:21,189.9 Second day, when you start taking these medications, you are really, if there are 255 people are given statin medication, only one will have possibly diabetes due to statins. 156 00:17:21,789.9 --> 00:17:26,609.9 But it will help 254 people to prevent heart attack and stroke and death. 157 00:17:27,209.9 --> 00:17:33,869.9 Are you one of those unlucky ones to have it? I have not come across anybody so far who had it. 158 00:17:34,344.9 --> 00:17:41,404.9 But these are the statistics from the experts who does this thing full time for the living on this topic. 159 00:17:41,854.9 --> 00:17:48,514.9 But I have never, I don't think it's even 1 in 255, but that's the statistics are. 160 00:17:49,114.9 --> 00:17:52,354.901 Other major criticism is that I will lose memory. 161 00:17:52,954.901 --> 00:18:20,104.901 That's something our dementia are developed if I take statin and they always give this explanation that our brain You had needs have a made up of the nerve cell coating Myelin is needs fats and it's made up of cholesterol and if we and then if the cholesterol level goes down the sheath will get smaller and the neurotransmitters levels will go down which is totally has never been approved. 162 00:18:20,704.901 --> 00:18:22,294.901 There was one small study. 163 00:18:22,684.901 --> 00:18:31,394.901 The unfortunate part is people can publish any data and then create a problem that we have to, after even 10 years, we have to explain. 164 00:18:31,924.901 --> 00:18:44,894.901 But that study showed that there is some people transiently It was not even a permanent, transiently, they have a mental fog, which was totally reversed once they stopped. 165 00:18:45,384.901 --> 00:18:46,894.901 But look at the data now. 166 00:18:47,494.901 --> 00:18:57,54.901 People who are on statins, they have a 62%, 62 percent less chances of developing dementia. 167 00:18:57,654.901 --> 00:18:59,724.901 Unless you have Alzheimer's disease. 168 00:19:00,324.901 --> 00:19:06,134.901 Most of the people who are diabetic, smoker, hypertensive, they develop vascular dementia. 169 00:19:06,664.901 --> 00:19:15,4.901 That vascular dementia chances decreases by 62 percent if you take statins. 170 00:19:15,604.901 --> 00:19:19,704.901 So that myth is completely backed by this thing. 171 00:19:20,304.901 --> 00:19:26,404.902 My recommendation is, if you have questions, you have a right to ask your physician. 172 00:19:26,864.902 --> 00:19:31,94.902 They write questions and get yourself educated. 173 00:19:31,104.902 --> 00:19:35,64.902 Don't take my word for it or any physician's word for it. 174 00:19:35,434.902 --> 00:19:42,534.902 We want you to understand that part, but don't write it off such an important medication. 175 00:19:43,134.902 --> 00:19:54,354.903 Yes, if you don't want to take the medication, change your life, but out of hundred, only five are the one who make sustainable. 176 00:19:54,954.903 --> 00:20:01,354.903 that they are following the recommendation, they are exercising, they are sleeping, they are eating right. 177 00:20:01,654.903 --> 00:20:03,34.903 Only 5 out of 100. 178 00:20:03,634.903 --> 00:20:09,234.902 And just imagine, 95 percent of the people will get back to what they were before. 179 00:20:09,604.903 --> 00:20:16,224.903 And that's why your physicians sometimes are more pushy to give you these medications, because we know that will help. 180 00:20:16,724.903 --> 00:20:19,884.903 But you do have a right to ask questions. 181 00:20:20,484.903 --> 00:20:27,714.903 And If after doing this one is that may still don't want to take the medication that will give you. 182 00:20:28,259.903 --> 00:20:34,299.903 a proper insight, and then hopefully you can make lifelong changes. 183 00:20:34,899.903 --> 00:20:40,239.903 Next question is, are statins are effective in primary prevention? That was a very intelligent question. 184 00:20:40,629.903 --> 00:20:45,679.903 First, understand what primary prevention, what is secondary prevention, and what tertiary prevention is. 185 00:20:46,279.903 --> 00:20:53,829.903 Primary prevention is that your average Joe, you never had any kind of cardiac event, whether a heart attack, stroke. 186 00:20:54,429.903 --> 00:21:01,439.903 Without this thing, the people who don't have, ever have, And if we give you cholesterol, how much that helps. 187 00:21:01,539.903 --> 00:21:05,89.903 That is called primary prevention before you develop disease. 188 00:21:05,219.903 --> 00:21:15,489.902 Second comes in is the secondary prevention is that you already have a stent, stroke, and when we give you this type of medication, how much they prevent. 189 00:21:16,89.902 --> 00:21:19,939.902 Absolutely, we, so far, we have been talking about secondary prevention. 190 00:21:20,409.902 --> 00:21:30,239.902 For primary prevention, statins are very, very effective, and they do prevent you from getting heart attack, stroke, and dying. 191 00:21:30,839.902 --> 00:21:35,759.902 How many people in the United States use statins? I checked it today. 192 00:21:35,759.902 --> 00:21:46,729.902 Actually, there are about 80 million people out of 300, 000, which we, uh, 300, 000, uh, 300 million people who live in the United States, 80 million people. 193 00:21:47,149.902 --> 00:21:49,939.902 are getting or they are on medication. 194 00:21:50,429.902 --> 00:21:54,689.902 And I think this number should be higher. 195 00:21:55,289.902 --> 00:22:01,639.901 Remember I said, I even are normal cholesterol, which we consider normal is abnormal and rest of the world. 196 00:22:02,239.901 --> 00:22:03,949.8 Statins are safe. 197 00:22:04,549.8 --> 00:22:19,809.801 You do not have to take the statins if you could make lifelong changes, but it's about 80 million people and use of statins is increasing because we are not Improving our lifestyle. 198 00:22:20,409.801 --> 00:22:27,469.801 What are the impacts of statins on mortality rate? Absolutely, all cause mortality goes down. 199 00:22:27,979.801 --> 00:22:30,649.8 Your mortality from dementia goes down. 200 00:22:30,979.801 --> 00:22:33,779.801 Dementia from heart attack, stroke goes down. 201 00:22:34,379.801 --> 00:22:40,549.801 What is the impact? Can statin cause muscle related side effects? Absolutely, I explained you that. 202 00:22:40,569.801 --> 00:22:43,579.801 It's about the, it's about 5 to 10 percent. 203 00:22:44,64.801 --> 00:22:46,694.801 But it's a hundred percent reversible. 204 00:22:47,294.801 --> 00:22:51,894.801 Do statins benefit beyond cholesterol lowering? I think that's a very intelligent question. 205 00:22:52,494.801 --> 00:22:58,964.801 Statins not only lower your cholesterol, in the inner lining of your blood vessel, they decrease the inflammation. 206 00:22:59,564.801 --> 00:23:06,764.801 And once you get a new heart attack, stroke, or PAD, the inflammation plays a significant role. 207 00:23:07,364.801 --> 00:23:09,134.8 They decrease the inflammation. 208 00:23:09,144.801 --> 00:23:14,64.801 That's why we get a lot of discussion, Doctor, my cholesterol is normal. 209 00:23:14,499.801 --> 00:23:24,159.8 Why do you want me to take cholesterol medication? Because they decrease the inflammation in the inner lining or the endothelial lining of your blood vessels. 210 00:23:24,639.8 --> 00:23:28,939.801 And that is very, very important and that helps a lot. 211 00:23:29,539.801 --> 00:23:33,159.8 Are there any difference between various statins? Yes. 212 00:23:33,729.8 --> 00:23:35,269.801 Statins are of two kinds. 213 00:23:35,299.801 --> 00:23:39,619.801 One is water soluble and other are Lipid soluble you. 214 00:23:39,709.801 --> 00:23:44,959.801 The common, the most prescribed medication, the word is Lipitor or atorvastatin. 215 00:23:45,409.801 --> 00:23:49,39.801 Simba and Simvastatin, they're fat soluble. 216 00:23:49,479.801 --> 00:23:50,289.801 Crestor. 217 00:23:50,889.801 --> 00:23:55,169.801 and, or Ruvastatin and the Prevastatin, they are water soluble. 218 00:23:55,769.801 --> 00:24:03,899.8 It is generally agreed and tested that the water soluble statins are better tolerated. 219 00:24:03,959.801 --> 00:24:06,909.801 They have less muscle side effects, less liver side effects. 220 00:24:07,259.8 --> 00:24:13,504.801 These days, and the good part is, Almost all the statins are generic. 221 00:24:14,104.801 --> 00:24:16,994.801 They, all of them are not branded. 222 00:24:17,224.801 --> 00:24:25,634.8 So, there is no higher copayments or anything, and you could get whatever brand you fancy and like. 223 00:24:25,944.8 --> 00:24:26,844.8 That will help. 224 00:24:27,444.8 --> 00:24:31,334.801 Can statin be used in children? That is a very touchy topic. 225 00:24:31,454.801 --> 00:24:32,624.801 Answer is yes. 226 00:24:33,174.801 --> 00:24:38,294.801 But, our children have a very, very bad cholesterol. 227 00:24:38,894.801 --> 00:24:46,804.801 If you look at the amount of soda they consume and the processed food they consume, their cholesterols are high. 228 00:24:46,814.801 --> 00:24:51,434.802 Even people as old as 15 to 20. 229 00:24:52,34.802 --> 00:24:56,404.801 I'm an adult medicine doctor, so we start seeing people after 20. 230 00:24:57,4.801 --> 00:25:00,974.801 When they come in for a periodization, their cholesterol has been high for three to four years. 231 00:25:01,304.801 --> 00:25:05,674.801 Answer is yes, it can be used in children and very elderly. 232 00:25:05,844.801 --> 00:25:07,294.801 It's considered very safe. 233 00:25:07,794.801 --> 00:25:17,44.8 This question that older adults, at what stage should we stop? First of all, age is not the reason to stop any medication. 234 00:25:17,644.8 --> 00:25:39,744.8 If you have a good quality of life, like today, 15 20 minutes ago before this session, I had a 90 year old person, the guy plays golf every, almost 3 4 times a week, he has a little bit of aches and pains, he had a high cholesterol, he takes statin, he didn't have any problem, these are the people we should never stop. 235 00:25:40,254.8 --> 00:25:43,964.8 But I have young people who already both the legs have been amputated. 236 00:25:44,444.8 --> 00:25:48,224.7995 They have a very severe heart failure and they are in hospice care. 237 00:25:48,224.7995 --> 00:25:52,584.8 Yeah, you, in those circumstances, these medications should not be given. 238 00:25:53,184.8 --> 00:25:57,284.801 What happens if somebody starts taking statins? Your cholesterol will go up. 239 00:25:57,314.8 --> 00:25:59,704.801 There is no withdrawal, dependence, this thing. 240 00:25:59,714.8 --> 00:26:01,374.801 These are very safe medication. 241 00:26:01,704.801 --> 00:26:02,714.801 This can be stopped. 242 00:26:02,714.801 --> 00:26:04,174.801 Certainly should not be done. 243 00:26:04,709.801 --> 00:26:12,529.801 without consulting physician for the reason you are taking cholesterol medication, but you will not have a statin later withdrawal if that was the question. 244 00:26:13,129.801 --> 00:26:19,609.8 Next question was, can statins reduce dementia? Absolutely, it is beyond doubt. 245 00:26:19,609.9 --> 00:26:21,819.699 62%. 246 00:26:22,419.699 --> 00:26:28,559.7 My goal today was to explain you a little bit about the cholesterol metabolism. 247 00:26:28,759.7 --> 00:26:31,689.7 We have a lot of videos on our channel on the cholesterol. 248 00:26:32,289.7 --> 00:26:35,799.7 You could watch them, then take up the questions. 249 00:26:36,214.7 --> 00:26:39,304.7 And different aspects of only status. 250 00:26:39,904.7 --> 00:26:42,944.7 In a nutshell, statins save life. 251 00:26:43,514.7 --> 00:26:45,434.7 They work very predictably. 252 00:26:45,754.7 --> 00:26:50,974.699 If you take statins, you could expect 50 percent reduction in your bad cholesterol. 253 00:26:51,424.7 --> 00:27:02,604.7 That will lead to 25 percent decreased risk of heart attack, 19 percent decreased risk of stroke, 9 percent absolute risk of reduction in death. 254 00:27:03,204.7 --> 00:27:07,224.7 62 percent less chances of having dementia. 255 00:27:07,824.7 --> 00:27:12,644.7 5 percent of people get muscle pain, 100 percent reversible. 256 00:27:12,654.7 --> 00:27:16,944.699 Few people get abnormal liver function test, 100 percent reversible. 257 00:27:17,544.699 --> 00:27:23,224.699 And plus, if any of you think you're superman, we are not. 258 00:27:23,824.699 --> 00:27:28,764.699 Same advice given only 5 percent of the people adhere to it rest of their life. 259 00:27:29,364.699 --> 00:27:33,594.698 So, talk to your doctor, ask them questions. 260 00:27:34,194.698 --> 00:27:36,274.697 Knowing is beautiful. 261 00:27:36,664.698 --> 00:27:39,884.698 If you don't ask the question, then we do not know what to do with you. 262 00:27:40,484.698 --> 00:27:42,284.698 You must ask the questions. 263 00:27:42,744.698 --> 00:27:45,584.698 And once you ask the question and commit. 264 00:27:46,184.698 --> 00:27:51,764.698 Then stick to the medication, get yourself checked regularly. 265 00:27:52,364.698 --> 00:27:58,314.698 One of the questions which we have answered in the previous videos is how frequently the cholesterol should be checked. 266 00:27:58,914.698 --> 00:28:09,74.698 If you don't, you're young and you're not on cholesterol medication and you don't have any of these events, then the recommendation is 3 to 5 years depending on your risk. 267 00:28:09,674.698 --> 00:28:15,734.698 Whether you're gaining weight, you're a smoker, you're exercising, it's all about risk stratification. 268 00:28:15,744.698 --> 00:28:18,634.698 It has nothing to do with 3 or 5 years. 269 00:28:18,714.698 --> 00:28:20,444.698 But 3 to 5 years is the one. 270 00:28:21,44.698 --> 00:28:31,634.698 Second concern is that if you are on a cholesterol medication, we do get into a lot of people, they say, I need to have cholesterol checked every three months. 271 00:28:32,234.698 --> 00:28:34,224.699 There is no rhyme or reason for that. 272 00:28:34,824.699 --> 00:28:44,944.7 If your cholesterol is high, you're in treatment, they have followed it up, you're rock stable, there is no liver problem, no, no CPK or muscle problem. 273 00:28:45,544.7 --> 00:28:49,454.7 Once a year follow up, it all depends on what's going on. 274 00:28:49,464.7 --> 00:28:54,154.7 There is no protocol that you should get every three months or every six months. 275 00:28:54,634.699 --> 00:29:00,354.699 I think that's where the relationship with your doctor, whosoever is prescribing you, comes into play. 276 00:29:00,954.699 --> 00:29:06,54.7 Your primary care physician is probably your best resource. 277 00:29:06,594.7 --> 00:29:11,64.7 He or she knows you the best, and they know you as a whole. 278 00:29:11,664.7 --> 00:29:17,14.7 This is a very difficult statement to make, but I have Review the data. 279 00:29:17,114.7 --> 00:29:26,134.7 Even the cardiologists whom you go all the time thinking that they are the saviour or the god of, or the angel of your heart. 280 00:29:26,734.7 --> 00:29:32,964.7 They have worse data regarding lowering your cholesterol and maintaining it as compared to primary care. 281 00:29:33,564.7 --> 00:29:36,4.7 Have a good relationship with your primary care. 282 00:29:36,364.7 --> 00:29:38,954.7 Open lines of communication and discuss. 283 00:29:39,554.7 --> 00:29:43,344.7 I hope I have answered most of your questions. 284 00:29:43,944.7 --> 00:29:48,814.7 If there is some part we did not touch, please write us in the comments. 285 00:29:49,414.7 --> 00:29:50,754.7 Like, share, and subscribe. 286 00:29:50,984.7 --> 00:29:53,24.7 Our channel name is KundalasMD. 287 00:29:53,574.7 --> 00:29:57,374.701 And I will see you next week with a different topic. 288 00:29:57,974.701 --> 00:30:03,344.701 We are creating online full courses, which is in production. 289 00:30:03,344.702 --> 00:30:07,634.702 And once it's produced, we will make it publicly available, free to everybody. 290 00:30:07,984.702 --> 00:30:10,224.702 Our goal is to simplify healthcare. 291 00:30:10,664.702 --> 00:30:20,944.701 and educate you and in turn let's spread the word and let's understand each other and be better patient and better doctors. 292 00:30:21,114.702 --> 00:30:21,964.701 Thank you very much.