One cardiologist's mission to reduce statin use for cholesterol | CNN (2023)

Editor’s Note: Dr. Elizabeth Klodas is a practicing cardiologist in Minneapolis and the creator of Step One Foods. This piece represents her views and not necessarily those of CNN.


High cholesterol? Here’s a pill. High blood pressure? Here’s two pills. High blood sugar? Here’s two pills and an injection. This is what many doctors routinely do without ever addressing why the cholesterol, blood pressure or blood sugar is abnormal in the first place.

I used to practice this way until I realized that all I was doing was covering up the downstream effects of poor diet with a bunch of drugs, instead of changing the food.

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I am a practicing cardiologist. I trained at some of the finest medical institutions in the world, including Mayo Clinic and Johns Hopkins, and have been repeatedly recognized for great patient care. But what I really want to achieve professionally is to put myself out of work.

Unfortunately, cardiologists have endless job security. And that’s because we’re treating the wrong thing. My waiting room was full of patients whose numbers I had made perfect but who still looked sick and felt terrible. Some even felt worse with all the drugs I had put them on. No cures, just a neverending revolving door of follow-up visits. This is not why I went to medical school.

what are statins cholesterol sje orig_00000000.jpg Statins' benefits beyond heart health aren't clear-cut, analysis says

Yet no one seemed to be doing anything about this or even acknowledging it. So I became obsessed with finding a better solution and founded a company that formulates foods to help lower cholesterol, backed by pharmaceutical-level science.

There may be 30,000 food items in the average grocery store, but none of them has been subjected to any real scientific scrutiny. They bear all sorts of checkmarks and heart symbols, but that tells only part of the story. For example, a cereal might contain fiber – and boldly tout the ability of this nutrient to lower cholesterol – but the fine print reveals that a serving of the cereal also delivers the added sugar equivalent of three cookies. Any positive health effect of the fiber is completely negated. But how is the average consumer supposed to know this? They’re not. They’re just supposed to like the taste and feel good about buying that cereal. My patients may have been trying to “eat better,” but they were getting duped.

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Two decades ago, the National Institutes of Health cholesterol guidelines mandated that changing diet should be tried for three months as the first step in treating high cholesterol, before putting anyone on drugs. But today, many of my peers expressed skepticism that a food-based solution could work.

It took more than 80,000 hours of training for me to become a cardiologist. How much of that time was spent on nutrition? Zero.

Treatment guidelines, representing the standard of care, only pay lip service to nutrition. For example, the American Heart Association’s latest cholesterol management guideline is 120 pages long. How much of that is devoted to diet? One paragraph. The guideline mostly instructs providers on which patient to put on which drug and at what dose. Children as young as 10, according to the guidelines, can be started on statin medications such as Lipitor and Crestor.

what are statins cholesterol sje orig_00000000.jpg Should you take statins? Guidelines offer different answers

In addition, physicians know only the prescription model. They are taught that the only truly valid proof of efficacy is a clinical trial and that everything else is conjecture. That’s why pharma rules, even though the literature is full of data about the health benefits of various foods. Food does not have “dosing data.”

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Did you know that doctors are monitored according to whether they prescribe medications? If I don’t follow the cholesterol guidelines by prescribing statins, insurers will send letters scolding me. If I don’t talk to you about the cholesterol-lowering effects of walnuts and oat bran, nobody cares. Physicians even get paid more when a drug is prescribed. A medical encounter that generates a prescription is considered more complex, which qualifies for higher reimbursement. In contrast, if a physician uses some of the very limited time with patients to talk about antioxidants and omega-3 fatty acids, they get nothing more.

My solution is to give physicians, insurers and especially patients an alternative food-based option for cholesterol lowering that could compete with drugs on every level. These foods taste great and are formulated using only health-promoting ingredients. They are dosed and measured and as easy to prescribe and use as medications. Most important, they yield clinically meaningful cholesterol reductions as confirmed by a clinical trial.

Given that 70 million Americans have high cholesterol, I approached big food companies and investors, naively thinking they would love my idea and want to help. They did not. Food manufacturers thought our ingredients (such as real almonds, walnuts, pecans and blueberries) were too expensive. They wanted to replace them with flavorings, artificial sweeteners and “fruit bits.” Investors thought the clinical trial we proposed doing to confirm efficacy was too uncertain. They told us we needed to have patents so we could charge prices like the pharmaceutical companies. No wonder this had never been done before. There was simply not enough profit in it. Patient health, it seems, is not very valuable.

NEWARK, NJ - AUGUST 13: A mans finger is pricked to test his cholesterol at the City of Newark's free homeless health fair at the Department of Child and Family Well-Being on August 13, 2009 in Newark, New Jersey. The Department of Child and Family Well-Being in partnership with other health organizations gave free medical examinations to the homeless including screening for high blood pressure, cancer, and diabetes. (Photo by Rick Gershon/Getty Images) Rick Gershon/Getty Images/File New cholesterol guidelines offer a more personalized approach

Undeterred, my supporters and I pushed forward and, supported by grant funding, conducted a trial in two countries testing our foods in statin intolerant individuals. These were people who are candidates for statin drugs but either can’t or won’t take the medications due to side effects, such as muscle aches. The only instruction to the study participants was: “Eat these foods twice per day instead of something you’re eating already,” without making any other lifestyle changes. Literally as simple as “take this pill twice per day.”

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The result was that 20%, 30%, even close to 40% cholesterol reductions were found in many individuals in just 30 days. This data was submitted at an American Heart Association meeting and will be submitted for publication. These medication-level cholesterol responses were obtained with food, without the need for dietary overhauls or exercise routines. They don’t just represent an option for the estimated 20 million Americans who are statin intolerant and have no other solutions but for millions more who need to lower their cholesterol but don’t need stains.

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As with medications, not everyone’s cholesterol will respond equally to a food intervention. Some people should be on statins even if their cholesterol is perfect. But given that it takes only a month of dietary change to determine whether you’re a food responder, doesn’t it make sense to give people the chance to at least try a validated food intervention before assigning them to a lifetime of pills? Especially since food doesn’t have any side effects, just side benefits such as lower blood pressure, better blood sugar control, weight loss and feeling better.

Food is the comprehensive solution to a complex problem. And it just might put me – and pharmaceutical companies – out of business.

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What does the Mayo Clinic say about statins? ›

Your doctor may recommend you take statins if you have high cholesterol and other heart disease risk factors, such as a family history of heart disease. Taking statins lowers your body's production of cholesterol and may lower your risk of heart attack, stroke and heart-related death.

What can I take instead of statins to lower cholesterol? ›

7 cholesterol-lowering alternatives to statins
  • Fibrates. Mostly used for lowering triglyceride levels in patients whose levels are very high and could cause pancreatitis. ...
  • Plant stanols and sterols. ...
  • Cholestyramine and other bile acid-binding resins. ...
  • Niacin. ...
  • Policosanol. ...
  • Red yeast rice extract (RYRE) ...
  • Natural products.

Why are doctors against statins? ›

While statins are highly effective and safe for most people, they have been linked to muscle pain, digestive problems and mental fuzziness in some people who take them and may rarely cause liver damage.

Why do cardiologists push statins? ›

Because many factors are involved, your cholesterol numbers may be considered normal and yet you may still be found to be at an elevated risk for heart problems. As a result, statin medications are now used to lower the risk of heart disease and heart events in most anyone found to be at high risk.

What should a 70 year old cholesterol be? ›

After having their cholesterol tested, seniors should be given a number between 190 and 260. Healthy seniors should keep their total cholesterol below 200 and their LDL cholesterol around 100. If your elderly loved one's LDL cholesterol level is above 160, he or she must start making sweeping lifestyle changes.

What is the best statin for the elderly? ›

Compared to a placebo, simvastatin reduced all-cause mortality by 13% and cardiovascular mortality by 27% regardless of age. Simvastatin decreased the rate of a first major cardiovascular event by 18% in participants aged 70–80 years (60).

What is the best drink to lower cholesterol? ›

There are certain drinks that can help maintain an ideal cholesterol level. Some of the best drinks for cholesterol management include green tea, pomegranate juice, citrus juice, soy milk, plant-based smoothies, and red wine.

What is the best natural alternative to statins? ›

9 Natural Cholesterol Reducers
  • Niacin.
  • Soluble fiber.
  • Psyllium.
  • Phytosterols.
  • Soy.
  • Garlic.
  • Red yeast rice.
  • Ginger.

What reduces cholesterol quickly naturally? ›

Oatmeal, oat bran and high-fiber foods

Soluble fiber is also found in such foods as kidney beans, Brussels sprouts, apples and pears. Soluble fiber can reduce the absorption of cholesterol into your bloodstream. Five to 10 grams or more of soluble fiber a day decreases your LDL cholesterol.

Can I refuse to take statins? ›

Before you refuse to take a statin or stop taking a statin, consult your doctor. He or she can explain why you may benefit from the drug or help you find a different statin if you experience side effects. We are constantly evaluating current methods for preventing and treating medical conditions.

Is it better not to take statins? ›

If your risk is very low, you probably won't need a statin, unless your LDL is above 190 mg/dL (4.92 mmol/L). If your risk is very high — for example, you've had a heart attack in the past — a statin may be helpful even if you don't have high cholesterol.

Do people refuse to take statins? ›

Fear of side effects and perceived side effects are the most common reasons for declining or discontinuing statin therapy. Willingness to take a statin is high, among both patients who have declined statin therapy and those who have never been offered one.

Are statins hard on your heart? ›

Statins don't just lower cholesterol levels but also reduce the risk of fatty plaques breaking off from walls of your arteries, reducing the risk of heart attack and stroke.

Can you get off statins once you start? ›

If you're taking a statin medication to lower your cholesterol, you will need to keep taking your prescription, or your cholesterol will likely go back up. Stopping your statin can put you at risk of having heart disease and other preventable health problems like stroke and heart attack from high cholesterol.

Do statins open clogged arteries? ›

A: Yes. There have been several clinical studies — many of them done here at Cleveland Clinic — that show statins can reverse plaque buildup. Two statins in particular, atorvastatin, which is sold under the brand name Lipitor, and rosuvastatin, which is sold under the brand name Crestor, are the strongest statins.

What should a 75 year old cholesterol be? ›

100 – 129 mg/dL is near ideal. 130 – 159 mg/dL is borderline high. 160 – 189 mg/dL is considered high. 190 mg/dL and higher is considered to be very high.

Does cholesterol matter after age 75? ›

What's more, it appears that having low cholesterol is linked to a higher risk of death from cancer, respiratory disease, and accidents in adults aged 80 and older. It also appears that the benefits of taking medications known as statins, which lower cholesterol, may lessen as people age.

Can you live a long life with high cholesterol? ›

Untreated or undertreated high cholesterol is associated with a lower life span due to the risk of heart attack and stroke, but it's still possible to live a long life with high cholesterol, provided you follow a heart-healthy lifestyle and take medication if needed.

Should 70 year olds take statins? ›

Statins are used to prevent heart attacks, strokes, and other life-threatening events associated with heart disease. Because strong evidence from clinical studies show the benefits of statins for adults up to age 75, doctors often prescribe them.

Should an 80 year old be on a statin? ›

Do not start a statin in patients ages ≥ 75 years who do not have known vascular disease or type 2 diabetes; start or continue a statin in all patients ages 75 to 84 with type 2 diabetes to prevent cardiovascular events and mortality; and start or continue a statin in patients ages > 75 years who have known vascular ...

What age should statins be stopped? ›

Adults age 75 and older may not need statins.

In fact, some studies show the opposite—that older people with the lowest cholesterol levels actually have the highest risk of death.

What is the number one food to lower cholesterol? ›

1. Oats. An easy first step to lowering your cholesterol is having a bowl of oatmeal or cold oat-based cereal like Cheerios for breakfast.

Is peanut butter good to lower cholesterol? ›

Due to its high amount of unsaturated fats, peanut butter may help reduce a person's LDL cholesterol levels. Having optimal LDL levels is linked with a lower risk of heart disease. A 2015 study found that people who had a high intake of nuts may have a lower risk of cardiovascular disease mortality.

How do you flush cholesterol out of your body? ›

Increase soluble fiber.

Soluble fiber can reduce the absorption of cholesterol into your bloodstream. Soluble fiber is found in such foods as oatmeal, kidney beans, Brussels sprouts, apples and pears.

How long does it take oatmeal to lower cholesterol? ›

6. Oats. Oats significantly improved blood cholesterol levels over a period of 4 weeks in a small 2017 study .

Can coq10 replace statins? ›

ANSWER: Although a coenzyme Q10 supplement may be helpful for some people who take a statin medication, no research studies have confirmed that it has benefits for everyone who takes statins.

Does green tea lower cholesterol? ›

Both green and black tea can help lower cholesterol levels. Green tea is prepared from unfermented leaves and black tea from fully fermented leaves of the same plant. Researchers believe that catechins, a type of antioxidant found in tea, are responsible for its cholesterol-lowering effect.

Which oatmeal is best for lowering cholesterol? ›

Whole-grain oats: Best bet for lowering cholesterol.

What lowers cholesterol the fastest? ›

Cardio exercise. Cardiovascular exercise, also known as cardio or aerobic exercise, is essential for lowering your cholesterol.

Does drinking water lower cholesterol? ›

When people have high cholesterol their LDL (bad) is high and their HDL (good) is low. Eating healthy, regular exercise and drinking plenty of water will help to bring down cholesterol levels within 2-3 weeks.

What are the two downsides of taking statins? ›

inflammation of the liver (hepatitis), which can cause flu-like symptoms. inflammation of the pancreas (pancreatitis), which can cause stomach pain. skin problems, such as acne or an itchy red rash. sexual problems, such as loss of libido (reduced sex drive) or erectile dysfunction.

Do cardiologists recommend statins? ›

The American College of Cardiology and American Heart Association developed some prescription guidelines. Typically, if a person's LDL cholesterol (bad cholesterol) is 190 or higher, they're often advised to start a statin.

Should I or shouldn't I take statins? ›

Statins should be taken with caution if you're at an increased risk of developing a rare side effect called myopathy, which is where the tissues of your muscles become damaged and painful. Severe myopathy (rhabdomyolysis) can lead to kidney damage. Things that can increase this risk include: being over 70 years old.

What is the safest statin to take? ›

Which cholesterol-lowering drug is the safest? Overall, statins are safe as a class of drugs. Serious adverse events are very rare. Among the individual medications, studies have shown that simvastatin (Zocor®) and pravastatin (Pravachol®) seem to be safer and better tolerated than the other statins.

Which statins cause memory loss? ›

Results: Of the 60 patients identified who had memory loss associated with statins, 36 received simvastatin, 23 atorvastatin, and 1 pravastatin. About 50% of the patients noted cognitive adverse effects within 2 months of therapy. Fourteen (56%) of 25 patients noted improvement when the statin was discontinued.

Why do patients refuse statins? ›

Fear of side effects and perceived side effects are the most common reasons for declining or discontinuing statin therapy. Willingness to take a statin is high, among both patients who have declined statin therapy and those who have never been offered one.

What does the American heart Association say about statins? ›

The ACC/AHA guidelines also recommend statins for patients with diabetes without having to also calculate a person's 10-year risk score and recommend statins for those patients with extremely high levels of cholesterol.

Can statins clear blocked arteries? ›

A: Yes. There have been several clinical studies — many of them done here at Cleveland Clinic — that show statins can reverse plaque buildup. Two statins in particular, atorvastatin, which is sold under the brand name Lipitor, and rosuvastatin, which is sold under the brand name Crestor, are the strongest statins.

What is the safest way to stop taking statins? ›

Reducing statin use
  1. Adding other cholesterol drugs. Drugs your doctor could add to your medication regimen while reducing your statin use include ezetimibe, bile acid sequestrants, or niacin. ...
  2. Adding L-carnitine supplements.
  3. Adding CoQ10 supplements.

Can statins damage your heart? ›

"It's up to the individual physician to make a decision." Which statin will lower your cholesterol? Since statins can cause muscle damage, they could theoretically also harm the heart--which is, essentially, a big muscle--although there is no evidence that this is the case.

Do I have to take statins for the rest of my life? ›

You usually have to continue taking statins for life because if you stop taking them, your cholesterol will return to a high level. If you forget to take your dose, do not take an extra one to make up for it.

Is there a natural substitute for statins? ›

Some people do not tolerate statins or may want to try natural remedies to treat their high cholesterol. Statin alternatives include some prescription medications like ezetimibe and fibric acids. Natural remedies that some people use to help treat high cholesterol include omega-3 fatty acids and red yeast rice extract.

What is a natural statin? ›

These are most commonly found in fruits, vegetables, including figs, avocados, nuts, oilseeds, oils such as rice bran, olive oil and whole grains, including barley, oats, whole wheat. Taking two grams of plant sterols or stanols per day usually results in a 10 per cent lowering of LDL (bad) cholesterol.

Is there a new drug to replace statins? ›

Ezetimibe. Ezetimibe (Zetia) is a medication that's often prescribed in cases where a statin alone isn't enough. If you've hit the maximum recommended dose of your statin but your cholesterol levels are still high, your healthcare provider might recommend it.


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