When Houston businessman Gerald Mitchell visited his cardiologist in early 2005, he was overweight, had high cholesterol and hypertension and a family history of heart disease and diabetes. A stress test revealed blockage in two arteries.

“I was a walking time bomb,” says Mitchell, 55, who was motivated to seek medical help after the recent death of his 57-year-old brother from a heart attack.

Mitchell’s doctor prescribed high doses – 80 mg a day – of Zocor, a cholesterol-lowering drug, or “statin.” He also was given several other drugs to lower his hypertension, and sent to the Wellness Center at Memorial Hermann Hospital. The combination of medications, diet and exercise produced dramatic results. Mitchell has reduced his total blood cholesterol more than 100 points – from 252 down to 133 – and his LDL or “bad cholesterol” to a healthy 79. And he has lost 23 pounds.

Mitchell hadn’t had an “event” – a heart attack or stroke. Nor had his doctors had to head disaster off at the pass through angioplasty or bypass surgery – but he was at high risk for cardiac problems. In addition to the early death of his brother, his mother died of diabetes and his 27-year-old sister had a heart attack and died. And cardiologists say he’s a prime candidate for high doses of statins.

“We’re putting people on statins who have no symptoms but who have stress tests which indicate they have blockages,” says Ward Casscells, M.D., professor of cardiology at The University of Texas Medical School at Houston and director of clinical research at the Texas Heart Institute.

Higher Doses Better, Study Suggests

All statins – Zocor, Lipitor, Mevacor, Pravachol, Crestor and Lescol – lower cholesterol through the same basic method: they inhibit a key enzyme that controls how much cholesterol is produced by the liver. The result is lower LDL, higher HDL (the “good” cholesterol), and a reduction in triglyceride level.

Statins have been around for a long time, but a new study suggests that high doses are more effective than previously expected at cutting the risk of strokes and heart attacks. Another new study shows that statins are still under-prescribed for many at-risk patients, and guidelines for lowering cholesterol levels are getting stricter all the time.

A simple blood test called a “lipid profile” is the best way to check your cholesterol. The most common cholesterol measurement is called a total blood cholesterol. But newer research and revised national guidelines are putting more importance on knowing your LDL and HDL cholesterol levels.

New Math

The LDL, or “bad” cholesterol, usually measures between 100 and 200, Casscells says, “but we like seeing it below 130. The goal now for people with established disease gets lower and lower. Now it’s down to 80, and some authorities think it should be 70.”

He himself pays a lot of attention to the HDL, the “good” cholesterol, and he likes to see “the ratio of total cholesterol divided by the HDL below three. Or in people with extensive disease I like to see it down to two.”

Casscells’s total cholesterol, for instance, is 220, but his HDL is high – 70 – “so my ratio is just over three,” he explains. His LDL “usually runs about 155, and that’s too high by today’s standards.” But the cardiologist has other tricks up his sleeve.

Eat Like a Mediterranean

Casscells doesn’t take a statin because he has no other risk factors, he says, and he’s vigilant about maintaining a Mediterranean-style diet, which is rich in fruit, vegetables, fish, and nuts and includes red wine. Casscells also eats a lot of uncooked vegetables, because “when you cook food you oxodize it, and if you take in some non-oxidized, non-cooked stuff you’re better off.”

Diet, Casscells says, “is an important part of the picture that’s getting a bit lost in the pharmaceutical marketing.”

Sharon Lechter Smalling, MPH, RD, LD, a clinical dietitian specialist at Memorial Hermann Hospital, agrees. She works with many at-risk clients like Gerald Mitchell whom cardiologists at the UT Health Science Center send to the hospital’s Wellness Center. She helped Mitchell work out a diet plan that includes fish four days a week, chicken three days, a lot of fruit, vegetables and salads and no red meat or starches.

Another Eating Plan to Consider

Smalling also is beginning to talk to clients about a relatively new vegetarian diet called the “Portfolio Eating Plan.” Several researchers have found that the diet is just as effective at reducing cholesterol as cholesterol-lowering drugs. The diet includes heart-healthy food like almonds, as well as soybeans and tofu, kidney and lima beans, apples and strawberries.

The diet may be too restrictive for most people to follow, and Smalling doesn’t suggest substituting it for statins. “But to try the diet may mean you can take less medicine,” she says. “So instead of taking 30 or 40 mg, maybe you can take a 10-20 mg dose and obviously save money.’’

The diet, which can be found on the Internet at www.portfolioeatingplan.com, doesn’t include red wine or chocolate, but both are also believed to be heart-healthy. “I don’t have any figures (on red wine),” Smalling says, “but it’s supposed to raise your HDL.”

And chocolate? “Dark chocolate is real high in anti-oxidants and shown to lower cholesterol levels.”

Gerald Mitchell, meanwhile, is happy that he decided to get serious about his health problems before it was too late.

“Why do people have to wait till they have a stroke or a heart attack before they do something?” he asks. “I’ve made adjustments in my lifestyle and I feel great.”

Each year, more than half a million people die from heart disease.

UPDATED: 8-11-2005

Editorial Board | Legal Disclaimer | Privacy & Security | Contact Us

©2000-2006 Office of Institutional Advancement, UT-Houston