In the news: Statins & Nutrient Interactions

Rx for Statins Expected to Rise Significantly

A number of studies have demonstrated that a healthy lifestyle of eating well, exercising regularly, managing weight and not smoking can be an effective strategy to combat the risk of heart disease for many (1). Most recently, for example, it was reported that participants in a prospective study who most closely followed the Mediterranean way of eating were 47% less likely to develop heart disease over a 10-year period (2).

However, not everyone can stick to a healthy lifestyle, and others at high risk of having a heart attack or stroke may benefit from taking a statin medication (e.g. Crestor, Lipitor, Zocor and others).

According to a 2010 report from the National Center for Health Statistics, about 1 in 4 Americans over the age of 45 took statins. But in late 2013, new guidelines were issued by the American College of Cardiology and American Heart Association, which call for statin use in a broader range of healthier people, including those likely to have a stroke or heart disease as they age. As a result, prescriptions for statins are predicted to increase significantly over the next decade.

Previously, cholesterol-lowering drugs were generally reserved for patents judged to have a 20% chance of heart attack. The new guidelines not only recommend statins for those with high odds of suffering a heart attack or stroke in the short-term, but also for those with a 7.5% risk of suffering a stroke or heart attack over the ensuing 10 years. The guidelines also include those most at risk of ischemic stroke – the elderly, African Americans and women.

For those taking statins, the FDA issued advice in 2014 on the potential side effects associated with its use

Statin Interactions: CoQ10, Vitamin D, Vitamin K2?

In addition to interacting with certain other drugs, statins can also interact with some foods and nutrients. Grapefruit juice, for example, may decrease the ability of the liver to metabolize some statins and should not be consumed at the same time as the statin.

The nutrient Coenzyme Q10 (CoQ) is required by the mitochondria in cells to produce energy as ATP. CoQ is manufactured in the body along the same pathway that produces cholesterol. Statins inhibit one of the key steps in CoQ synthesis, and statin use has been associated with a reduction in blood and muscle tissue CoQ levels. A review on the CoQ-statin interaction notes that the elderly appear to be more susceptible to CoQ deficiency, as are the physically active who require the most efficient use of oxygen consumption by mitochondria (3).

Some researchers have recently proposed that statins may also interfere with the transformation of vitamin K1 (phylloquinone) to vitamin K2 (the menaquinones) in some tissues (4). Whether this potential interaction is of clinical importance isn’t known, but increasing dietary intake of vitamin K2 through fermented foods (e.g. cheese, curds, and natto) may be a good idea. Vitamin K2 is required by a protein thought to play a role in the prevention of age-related vascular calcification (see Staying Healthy, June issue).

A favorable interaction of vitamin D with statins is also a possibility according to a recent clinical trial of patients with high cholesterol given 2000 IU vitamin D or placebo daily along with a statin (5). At the end of 6 months, total cholesterol and triglycerides levels fell significantly more in the vitamin D group compared to placebo, and the effects were more pronounced for those with lower vitamin D levels at the study’s start. Results of a previous trial suggest that the lipid-lowering effects of vitamin D are limited to statin users, and likely due to a reduction in cholesterol absorption (6).

References

1. Chiuve SE, et al. Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men. Circulation 114:160-167, 2006.
2. Georgousopoulou E, et al. Adherence to Mediterranean is the Most Important Protector Against the Development of Fatal and Non-Fatal Cardiovascular Event. Presented at the American College of Cardiology's 64th Annual Scientific Session in San Diego, March 15, 2015.
3. Deichmann R, et al. Coenzyme Q10 and statin-induced mitochondrial dysfunction. Ochsner J 10:16-21, 2010.
4. Okuyama H, et al. Statins stimulate atherosclerosis and heart failure: pharmacological mechanisms. Expert Rev Clin Pharmacol 8:189–199, 2015.
5. Xiao FQ, et al. Effects of vitamin D on plasma liopids in stat-treated patients with hypercholesterolemia: A randomized placebo Controlled trial. Clin Nutr 34:201-06, 2015.
6. Kane L, et al. Vitamin D3 effects on lipids differ in statin and non-statin-treated humans. J Clin Endocrinol Metab 98:4400-09, 2013.