My Forsyth _ Spring 2023
Women in Business, Homeownership, Finances, Food, Health & Wellness, and Architecture are just a few of the articles you'll find in the latest issue of your community magazine. Sit back and enjoy. Happy reading!
Women in Business, Homeownership, Finances, Food, Health & Wellness, and Architecture are just a few of the articles you'll find in the latest issue of your community magazine. Sit back and enjoy. Happy reading!
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CHOLESTEROL<br />
JUST SAY NO<br />
TO CHOLESTEROL-<br />
LOWERING SUPPLEMENTS<br />
Elevated LDL cholesterol (bad<br />
cholesterol) is considered the most<br />
significant risk factor for coronary<br />
artery disease. It leads to a buildup<br />
of plaque in the heart, in the head,<br />
and in the lower extremities leading<br />
to heart attacks, strokes and<br />
amputations. Diet and exercise are often<br />
used to improve cholesterol but unfortunately<br />
have limitations. Exercise raises the good<br />
cholesterol (HDL) but has little impact on<br />
LDL levels. Dietary measures can lower LDL<br />
cholesterol between 10-25% but often much<br />
more significant LDL lowering is needed.<br />
The majority of our cholesterol is actually<br />
synthesized in the liver, and we have no direct<br />
control over it. Dietary supplements have<br />
been used and marketed as helping lower<br />
LDL cholesterol. Although millions of dollars<br />
are spent on the supplements there has been<br />
very little data supporting its use. This year<br />
the Cleveland Clinic, often recognized as the<br />
leading cardiac Center in the United States<br />
published the SPORT study. It compared the<br />
By Narendra Singh, MD<br />
lowest dose of rosuvastatin (Crestor) 5 mg<br />
against six commonly use dietary supplements<br />
marketed to improve heart health including<br />
fish oil, garlic, cinnamon, turmeric, plant<br />
sterols, red yeast rice, and placebo.<br />
After one month of treatment the results<br />
were unequivocal. Low dose rosuvastatin<br />
effectively lowered LDL cholesterol by 38%<br />
while placebo dropped LDL cholesterol by<br />
2.8%, fish oil by 3.4%, cinnamon by 0.4%,<br />
turmeric by 1.3%, plant sterol by 4.4%, red yeast<br />
rice by 6.6% and garlic actually raised LDL<br />
cholesterol by 5.1%. Other markers of note<br />
were that cinnamon worsened inflammation<br />
by 29% while rosuvastatin lowered it by<br />
5.7% and plant sterols lowered it by 13.7%.<br />
Cinnamon also worsened the good cholesterol<br />
by 2.3% and plant sterols reduced by 4% while<br />
rosuvastatin raised good cholesterol by 3.4%.<br />
It is clear that supplements do not work<br />
to lower bad cholesterol so while they can be<br />
used for other reasons the concept that it is<br />
promoting heart health needs to be revisited.<br />
Fortunately, when it comes to pharmacological<br />
options to lower LDL cholesterol more options<br />
now exist. Statins remain the first choice to lower<br />
LDL cholesterol. They are well proven to reduce<br />
the risk of heart attacks, strokes, limb loss and<br />
cardiovascular death. They work by shutting off<br />
the liver’s production of cholesterol. The main<br />
side effect of statins is muscle aches and pains<br />
and if a lower dose or an alternative statin is<br />
not successful in relieving the symptoms then<br />
other options should be considered. Ezetimibe<br />
(Zetia) can be used in conjunction with statins to<br />
further lower LDL cholesterol by preventing the<br />
absorption of dietary cholesterol.<br />
Injectables focusing on inhibiting a protein<br />
called PCSK9 are very effective at lowering<br />
LDL cholesterol. Alirocumab (Praluent) and<br />
evolocumab (Repatha) are taken every 2<br />
weeks and inclisarin (Leqvio) only needs to be<br />
taken twice a year. These agents are very well<br />
tolerated with none of the statin side effects but<br />
are more expensive.<br />
Most recently, Bempadoic acid (Nexletol)<br />
has come on the market. This drug also works<br />
by reducing the production of LDL cholesterol<br />
by the liver but unlike statins, does not get<br />
into muscle tissue and has no muscle related<br />
side effects. It does however increase uric acid<br />
and should be avoided in individuals with a<br />
history of gout. Recently a major study using<br />
this compound called CLEAR confirmed that<br />
it reduces the risk of cardiovascular death,<br />
myocardial infarction, stroke, and the need for<br />
coronary revascularization.<br />
As always, contact your health care team to<br />
determine the best course of treatment for you.<br />
NARENDRA SINGH, MD,<br />
FRCP(C), FACC, FAHA<br />
Preceptor- Mercer University, Atlanta, GA<br />
Director, Clinical Research, NSC Research, Atlanta, GA<br />
Director, Canadian Collaborative Research Network<br />
Affiliated with Piedmont, Northside and Emory Health<br />
Systems<br />
Recognized expert in South Asian Heart Disease.<br />
1100 Northside <strong>Forsyth</strong> Dr, Suite 345,<br />
Cumming, GA, USA, 30041,<br />
Phone 678- 845-8960<br />
5400 Laurel <strong>Spring</strong>s Parkway, Suite 1401,<br />
Johns Creek, GA, 30024<br />
Phone 678- 208-0165<br />
Email-DrSingh@nscresearch.org or<br />
DrSingh@nsccardiology.com<br />
www.heartdrsingh.com<br />
34 MYFORSYTHMAG.COM SPRING <strong>2023</strong>
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