Monday, December 13, 2010

Heart and cancer risks: life's a gamble

The treatment for heart-risky cholesterol levels is generally a three-legged stool: exercise, diet, and statins, a pharmaceutical. But there are risks—a risk if I kick out the stool’s statin leg, and a risk if I don’t.
Should I rely on statins to help improve my cholesterol levels, and gamble that they will not cause pain and loss of muscle strength?

Or should I gamble that I can improve my cholesterol levels and reduce my heart risk by exercise and diet, without statins? If that gamble doesn’t work, what will it do to my risk of more big heart trouble?

And what about the cancer risks that Joan and I both face? Joan has skin cancer. Regular treatment by a dermatologist has it under control, but it has the potential to be a serious problem. Several years ago, Joan underwent a major operation that completely removed a threatening cancer. I’ve had colon cancer. It was detected and removed at a very early stage, leaving no adverse effects, but, as with Joan, it highlights an element of risk..

Foods and exercise that affect heart risks also affect cancer risks. So how we deal with the heart will, to at least a significant degree, affect how we deal with cancer.
Statins are used to reduce the risk of cardiovascular disease by reducing the amount of LDL (low-density lipoprotein) cholesterol in your blood, and increasing HDL (high-density lipoprotein). LDL tends to clog the arteries, causing heart trouble; HDL helps to flush it out. Lipitor is the best-selling statin, and the world’s biggest selling pharmaceutical. I had been using Lipitor for many years, since my cardiac arrest in 1989. But there can be side effects. Serious muscle weakness and pain is one possible side effect.

For me, aching leg muscles have been a bit of a sore point—if you’ll pardon a pun—that goes a long way back. When I was a little boy, perhaps nine or 10, there were nights when the pain in my legs brought me close to childish tears. “Growing pains,” my parents said. Mother applied Sloan’s Liniment. I can still see on the bottle the picture of Dr. Sloan, with his beard that touched his bellybutton, and smell the odour, strong enough to make you plug your nose. As soon as it was applied, the ache of the muscles was no longer noticed, overpowered by the burning fire of hot liniment.

I felt aching leg muscles again during the past year or so as I hiked more than a thousand miles to train and participate in my first marathon, a 42-km walk, followed less than two weeks later by a four-day, 125-km hike; and now at times when I work for an hour, or even two, on my exercise bicycle, pedaling with both my legs and arms. These are normally healthy aches that can come from aerobic exercise. Yet I am suspicious that the aches are exacerbated when I use the statin medications, Lipitor or Crestor.  Is that just my imagination? Is it psychosomatic? Am I like the guy who declared, “Thank goodness I don’t have hypochondria: it’s the only thing I haven’t got.”

It was a friend who inadvertently brought the risk to my attention. We had not seen her for quite some time until about two years ago when we were surprised to find her walking with a cane. “Lipitor,” she explained. “There are scores of law suits about what it has done to muscles.” Pfizer, the maker of Lipitor, has, indeed, been embroiled in lawsuits. Lipitor has saved millions of lives. There is no doubt that. There is also no doubt in my mind that—if it is possible—it’s better to achieve the same result without the use of a pharmaceutical. And Pfizer warns that side effects its statin can include diarrhea, upset stomach, and “changes in some blood tests.” More ominously, a Pfizer advertisement also warns that “…any new muscle pain or weakness… could be a sign of rare but serious muscle side effects.” I’m uncertain just how rare that might be. If Google “Lipitor and muscle pain” you will get more than 3.5 million hits.

I felt pretty good about my cholesterol levels when I saw the latest readings in late October during our semi-annual visit with our family physician, Dr. Maria Cescon. At least I did until Dr. Cescon pointed out what I had overlooked. LDL cholesterol of less than 5 millimoles per litre of blood (mmol/L) and HDL of more than 1, are considered safe by the College of Family Physicians of Canada. My LDL level was 2.95 and my HDL 1.61—very good by those particular guidelines. Except those guidelines are for people at low risk of heart trouble. “If you’ve already had a heart attack,” say the Family Physicians, “your LDL needs to be less than 2.0 mmol/L.” Dr. Cescson says it should be down to 1.8.

“Exercise has clearly not been enough,” Dr. Cescon said, in prescribing Crestor, at half the strength I had once taken Lipitor.

There might, however, have been some good effect from all that walking. I had already stopped taking Lipitor, even at half strength, during the six months since my previous blood tests. Between the two test periods, my LDL level declined more than 8% (from 3.21 to 2.95 mmol/L), which was good—but not good enough. Not so good was a slight increase in HDL (from 1.68 to 1.61).

Now, Dr. Cescon was urging me to try Crestor.

What to do? Should I take the Crestor and the supposedly rare risk of severe muscle failure? Or should I forgo the statin and gamble that exercise and diet can improve my cholesterol to the recommended levels?

I am continuing my bet on diet and exercise. I am gambling that, with a little extra effort are care, this time it will improve my cholesterol levels, without statins. I am adjusting my exercise to a modestly higher level of aerobic intensity. At least one researcher claims that walking isn’t sufficiently aerobic to improve cholesterol levels. We are also adjusting our diet to focus more tightly on foods that fight heart and cancer risks. Fortunately, they are pretty much the same foods—close enough to combine them in a diet. And in generally they are overall the healthiest foods.

Will the gamble work? Will it reduce my risk of heart failure? Or will it increase it?

We won’t have an indication for nearly five months, until April 26 and our next checkup with Dr. Cescon, when we will get the results of our next blood tests.

And what about our cancer risks? There is no similar cancer-risk marker to be revealed on a particular date, yet the effects of diet and exercise on cancer and heart risks seem as closely bound as pages in a book.

Our little health concerns are really of no consequence nor interest to others. What might be of interest is to see if, and to what extent, my exercise and diet succeed in replacing statins to reduce heart risk. And how that might also reduce cancer risks. So it could be interesting to see what April 26 brings.

The best foods to fight heart and cancer trouble, as suggested by dietitians, and food and health researchers, will be the subject of my next blog. After that, we’ll talk, from time to time, about what we are doing to incorporate these foods in our meals and menus.

It will be an adventure you can follow on my blogs.

TAGS. Cardiovascular disease. Cancer. Exercise. Diet. Muscles. Muscle pain. Statins. Lipitor. Crestor.

1 comment:

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