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HEALTH MATTERS: Aches associated with lower cholesterol meds

Dr. Joshua Wynne

Q. Several of my friends have developed muscle aches while taking different medications to lower cholesterol levels. How common is this, and what can be done about it?

A. The most common type of medicines by far that we use to treat high cholesterol values are called statins; there are several available, and they all work by blocking a key step in the biochemical pathway that leads to cholesterol production.

Two types of muscle problems may be seen — pain associated with damage to the muscle, which occurs in 1 to 5 percent of patients, and just muscle aches without evidence of damage, occurring in up to 20 percent (or one in five) treated patients.

While I often order a blood test for my patients to be sure that no muscle damage is present when they complain of statin-associated muscle aches, it is rare indeed for me to see any evidence of muscle damage in my practice, which is a good thing because it can be quite serious and lead to kidney failure among other problems. But muscle aches and pains — called myalgias — are common.

They may respond to lowering the dose or a change to another statin. And sometimes a brief holiday of not taking the offending medication works, so patients can restart it after a few weeks off the medication. In some patients, the aches are mild enough so they just soldier on. So, one way or the other, we usually can come up with a plan that works for the patient, once we are sure that there is no evidence of muscle damage caused by the statin.

Q. I’m trying to follow a heart-healthy diet and avoid saturated fats while eating a lot of fish and other foods high in polyunsaturated fats. Am I doing the right thing?

A. Unfortunately, I can’t give you an answer any more definitive than “maybe.”

Dietary fats are said to be saturated, monounsaturated or polyunsaturated based on the number of internal bridges (or bonds) that make them up. For years, in an effort to achieve an optimal cholesterol level and thus reduce the risk of heart disease, we have recommended a diet high in polyunsaturated fats as is found in fish and certain plants such as soybean, sunflower and corn oils, and low in saturated fats as is found in various meat and dairy products.

But a recent review looked at the aggregated findings from 76 studies involving more than 600,000 participants that compared fatty-acid intake and the risk of associated coronary heart disease. The review found no convincing evidence that there is any association between a fatty-acid diet and coronary heart disease. So, while there may be some benefit to following a low-saturated and high-polyunsaturated fat diet, the extent of the benefit would seem to be pretty small.

So, how then to optimally reduce the risk of heart disease? Do the simple stuff — don’t smoke; make sure your blood pressure is well-controlled; treat elevated cholesterol levels with medication as indicated; keep your weight down; and exercise sensibly. And while it’s fine to eat fish, doing so probably doesn’t dramatically lower your risk of developing a heart attack, but enjoy nonetheless.

Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.

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