If cholesterol is not lowered (despite the diet) are drugs needed? – breaking latest news

I am 52 and have always had high total cholesterol. A few years ago I was ablated for paroxysmal atrial fibrillation with a good outcome (ablation is a minimally invasive practice used in the treatment of arrhythmias in which lesions are performed on the atrial tissue to electrically isolate some areas, ed). I have no other heart problems. I would like to understand why, despite the healthy diet, my cholesterol does not go down. The doctor offered me statins, but I’m very doubtful. I tried natural statins (fermented red rice / monacolin K) for a month, which gave me severe muscle ailments. Last year I followed a strict diet and started supplementing with berberine and silymarin, with excellent results. Trying a bit to widen the diet and cutting back on supplements, I am almost back to square one. How can I continue now?

He answers Emilio AssanelliHead of the First Aid and Emergency Cardiology Unit, Monzino Cardiology Center, Milan (GO TO THE FORUM)

The correlation between increased cholesterol levels and the incidence of cardiovascular events is known and demonstrated. However, other factors also play a role in determining cardiovascular risk, which must therefore be periodically estimated in its globality. In primary prevention, the first step towards correcting hypercholesterolemia are changes in diet and lifestyle. Physical activity, weight reduction and the adoption of certain dietary rules such as il reduced intake of fatty foods (30 grams per day), in particular of saturated fats, help to improve the lipid picture as a whole, also reducing plasma triglyceride levels. If this is not enough, you can take natural substances; among the most frequently used we find monacolin K and berberinethe effectiveness of which confirmed by numerous studies.

When you can use them

Monacolins are a group of molecules produced by the fermentation of red rice and work by inhibiting one of the enzymes involved in the synthesis of cholesterol by the liver. However, they can have some side effects: muscle pain, liver damage or gastrointestinal upset. Berberine, on the other hand, an alkaloid contained in the root of hawthorn and other plants and reduces plasma cholesterol by increasing the hepatic removal of Ldl lipoproteins, through the growth of the expression of hepatic receptors. Furthermore, berberine can reduce the hepatic synthesis of triglycerides, reducing their plasma values. Currently available supplements can actually reduce cholesterol levels, but their use should be reserved mainly for individuals with an absolute low cardiovascular riskat a young age and according to cardiovascular risk algorithms well codified by current European guidelines.

Cardiovascular risk

In the event that non-pharmacological strategies are not effective or the cardiovascular risk is high, it is necessary to undertake therapy with drugs and the first choice concerns the use of statins. Therefore, in your case, only after a careful examination of the overall cardiovascular situation that takes into consideration its risk factors and the presence of any subclinical organ damage, can the implementation of the statin be indicated to reduce LDL cholesterol levels. . In fact, reducing cholesterol remains one of the most effective weapons to reduce cardiovascular risk and mortality and total, as well as to obtain a minor progression or even a modest regression of atherosclerotic lesions of the coronary arteries.