Katerina Pothoulakis 4/26/16 Katerina Pothoulakis 4/26/16

Do you know what Statins are? If not, you should ….

Statins: the Pros and Cons of a Heavyweight

Statins are life saving medications, literally. In the fight against heart disease, they are credited with reversing the tide of rising heart attacks. Of course, the decline in smoking and better use of blood pressure medications has helped with the reduced rate of heart attacks. The good news is that, since 1996, for the first time in over a century, we have seen a decline in heart attacks by 40-percent.

Statins are a group of medications that lower the bad (LDL) cholesterol and reduce inflammation in our arteries. They help stabilize cholesterol plaques that frequently (and permanently) reside in our heart and brain arteries. Statins keep the blood flowing and reduce heart attacks and strokes by 30 to 40 percent.

Since statins are a true heavyweight champion of modern medicine, they are among the most widely prescribed medications in the US (almost 20 million patients use them). Although they generally have a very good safety track record, statins also have a dark side.

The greatest problem with statins is that they are not muscle friendly. About one in five statin users develops muscle aches, pains or stiffness that, although not life-threatening, can cause discomfort and suffering. To many affected statin users, these symptoms make the expected benefits not worthwhile. Other negative aspects of statin use are much more rare and include severe liver damage (one in a million), kidney failure (one in ten thousand), or type 2 diabetes (one in a thousand).

For some individuals healthy choices may include statins, on top of a healthy lifestyle. The decision to start statins (and continue them for the rest of your life) should be based on your particular risk for developing heart attack or stroke. Individuals with the highest risk include (but are not limited to) those who have:

already suffered a heart attack, a stroke or mini stroke
undergone bypass surgery or stent placement
either type 1 or type 2 diabetes
an LDL cholesterol above 190 mg/dl.

As you discuss with your doctor whether statins are right for you, you need to weigh the good and the bad when it comes to the side effects of statins. You must consider how statins can help your arteries and prevent life-threatening conditions that may be points of no return, like heart attacks and strokes.

Keep in mind that doctors routinely check (through a simple blood test) for severe liver or muscle damage. They may also recommend over the counter supplements (like Coenzyme Q-10 or Vitamin D) that can protect against muscle aches. Doctors also warn their patients that, in case of severe muscle aches or dark-color urine, they should promptly stop taking statins.

The list of the currently available statin medications includes:

Crestor (rosuvastatin)
Lescol (fluvastatin)
Lipitor (atorvastatin)
Livalo (pitavastatin)
Mevacor (lovastatin)
Pravachol (pravastatin)
Zocor (simvastatin).
Advicor (lovastatin/niacin extended-release)
Simcor (simvastatin/niacin extended-release)
Vytorin (simvastatin/ezetimibe).

Good health to you!

Anthony Pothoulakis, MD, FACC

Katerina Pothoulakis 4/12/16 Katerina Pothoulakis 4/12/16

Is Skinny Really Healthy?

The obesity epidemic is real and has been for the last twenty-five years. Now it is spreading well outside the boundaries of developed nations. It brings along health concerns: type 2 diabetes, heart disease, stroke, and destroyed knee joints. There have been strong and concerted attempts to cure this epidemic and promote the image of a healthy, non-obese human body. But is becoming skinny at all costs the right answer?

Skinny or normal weight individuals who workout almost daily and eat right can also be suffering poor health. It is not unusual for normal or low to normal weight individuals, to have a very high LDL (the bad cholesterol) or high blood pressure. These conditions depend on heredity and aging as much as they do on lifestyle. Unfortunately, a great body is easier to see and detect than high LDL or high blood pressure. If one or both of those conditions has been a problem for years and goes undetected, it could destroy arteries and hearts beyond repair. Furthermore, many health conscious individuals who are thin, fit and eat healthy, have strong convictions against taking anything that is not natural; they are among the hardest to persuade that a pill might be medically necessary for them.

Muscular individuals may not appear skinny but are certainly healthy. If their muscle comes without belly fat, they are doubly healthy. First, they are spared of the toxic effects of belly fat. Second, muscle is metabolically wonderful. It will burn calories even when we are asleep and suck in excess fatty acids and blood sugar. Third, muscle is essential for exercise and later in life, for simply staying functional and able to walk. One caveat: lifting very heavy weights may raise the blood pressure to unsafe high levels and can destroy our aorta and heart, thus it is not recommended.

There are several conditions that can be even more destructive to our health than obesity.

Smoking is number one. The use of tobacco products, in any way or form, can destroy our arteries and cause heart attacks, stroke, heart failure and an assortment of cancers. Smoking can cause you to stop breathing, due to emphysema. This is irreversible. Since smoking reduces appetite, it is not unusual for smokers to have great figures. If these smokers could only see their insides. The ragged terrain of their arteries and their cancer cells in the making are not a trade off for a shapely body!

Trying to become skinny is not the “end all be all”. We know there are negative health consequences of anorexia and an extremely low body weight (a BMI below 18.5 or a waist circumference below 29 inches for men or 25 for women). In an all- out- war against the obesity epidemic and the ravages that come with it, we should see optimal body weight in the right perspective: desirable. Skinny is neither an absolute guarantee of health nor a goal in itself to be conquered at any cost or through any means. To your Health!

Katerina Pothoulakis 3/22/16 Katerina Pothoulakis 3/22/16

New Year’s Health ‘Re-Solutions’

The first quarter of 2016 is almost over, and chances are you did not stick to your New Year’s resolutions. Don’t fret, use this as a time to make your resolutions into “RE-solutions”.

A healthy lifestyle is most important - this means living healthy, eating healthy, exercising and making good choices in your life. Don’t get hung up on the numbers on the scale. Fitting into that dress from 2 years ago, or those pants you wore last year is not necessarily as important as living your life in a healthful way.

A healthy lifestyle means a healthy diet. This means six or more portions of fresh fruits and vegetables, and taking in good fats and lean protein. Try to limit the intake of salt and sugar in at least 90% of your meals (this will help to lose weight too), and stay away from bad fats.

Drinking only moderate amounts of alcohol is acceptable, which means no more than one alcoholic beverage daily for women or two for men.

Near daily exercise is important in a healthy lifestyle. This includes a combination of aerobic exercise, - light or moderate weight resistant, and stretching.

Avoid prolonged or unnecessary use of non-steroidal anti-inflammatory medications (‘NSAIDs’).

If you smoke - stop immediately. The effects of smoking are dangerous and do not lend to a healthy lifestyle.

The practice of a healthy lifestyle should be coupled with monitoring blood pressure and LDL cholesterol (with the help of your doctor) and with keeping your wellness visit appointments.

Losing weight as a new year’s resolution is a cliché. Losing that extra 5, 10, or 15 pounds is not as important as the consistent practice of a healthy lifestyle (and keeping your blood pressure and LDL cholesterol low). Weight loss can be difficult-if not impossible- to achieve and the struggle to lose weight may be a frustrating uphill battle. If it turns into a daily nightmare it can make you feel worthless and give up on your health altogether. The best part is if you institute and follow a near-daily practice of a healthy lifestyle... very often over time, you will find you lose that extra weight.

Here is a list of “RE-Solutions”:

If you smoke, quit. Daily exercise and a perfect diet won’t come even close to offering you the health benefits of quitting smoking. Smoking can destroy your arteries (giving you heart attacks and strokes) and your lungs (causing emphysema) and contribute to an assortment of cancers. Smoking is essentially negating all the other healthy choices you are making.

If you have high blood pressure, eliminate salt from your diet. Take your medications, and monitor your blood pressure at home, aiming at the blood pressure goals that your physician recommends for you (less than 140/90 mm Hg, or even lower, depending on your medical history).

If you are diabetic, do whatever it takes to keep your A1c at the level your physician recommends (around 7% or even lower, again depending on your unique health circumstances). Monitor your blood sugar and blood pressure at home and discuss with your doctor whether a statin is appropriate for you.

If you have high cholesterol, eat at least six portions of fresh fruits and vegetables a day. Take in the good fats, that can be found in the forms of fish, olive oil, unsalted nuts, or dark chocolate. Discuss with your doctor whether medications are necessary.

If you are overweight or obese, eat a healthy diet and exercise at least five times a week. Exercise should including not only aerobic but also resistance and stretching exercises. Do not smoke, do not drink more than moderate amounts of alcohol, make your home as sugar-free as possible, and keep your blood pressure and LDL cholesterol low (with the help of your physician). If your obesity has already caused significant health problems, discuss with your doctor about bariatric surgery and obesity-treating medications.

Remember: it is what we do on most of our days that counts. Good health is built or destroyed, one day at a time.

Don’t get hung up on that scale, and remember each journey starts with one step. So make that first step today and start toward a healthy lifestyle. So what if it’s not January? So you broke your resolution? This is your “do-over” , your mulligan, your chance to start again! Make the decision today to hit the reset button and start that healthy lifestyle. Have a most healthy (rest of ) 2016!