OPINION: New AHA/ACC Statin Guidelines

statinsI am greatly concerned with the new statin guidelines recently released by the American Heart Association and the American College of Cardiology during the yearly Scientific Sessions held in Dallas this November. Guidelines introduced to the public with great fanfare, and covered by all National media outlets.

These guidelines take healthy people and input certain risk factors that include age, body weight, smoking history, family history of heart disease, blood pressure and cholesterol levels to determine future cardiovascular (CV) risk. Those that are found to have a CV risk of 7.5% or greater, in the following 10 years would be candidates for statins. (Statins were first introduced in 1987, and over the years, their use has increased. The annual expenditure in 2000 on statins: $7.7 trillion, by 2007: $20 billion). These medications help reduce the amount of cholesterol and LDL (so-called bad cholesterol) in the blood. It is believed however, that statins work in decreasing heart disease because they decrease the degree of inflammation. An effect is given the name pleotrophic effect.

Under the new guidelines, an additional 31 million people would meet criteria for these drugs. Currently, about 15% of all adults in the U.S. take statins and the new guidelines would double it to around 33%. Generalizing treatment to a wide cross section is of concern, because the likelihood of success or failure of a treatment is not identical in all individuals treated, because therapy is not the only determinant of outcome.


It is this continued reliance and focus on drugs that concerns me. I am also concerned and confused with the frequent changes, recommendations and mixed messages made by the medical establishment. How often do we read a medical “expert” recommending one thing, only to have another “expert” recommend something completely opposite, contraindicating the first expert? In a country with so many “experts,” it’s no wonder why patients (myself included) don’t know who or what to believe.

Are we really so sure we should proceed to double the number of U.S. adults on statins as suggested by the new guidelines? Can we be so sure that the benefits of this class of medicines outweigh the risks? We know that the use of statins short-term has side effects in some patients, but what happens after 10 or 20 years of use?

cholesterolCholesterol is not a villain. The absorption of vitamins and minerals including vitamin D, is dependent on cholesterol, which is why our bodies produce it. Multiple studies have shown that statin users have higher rates of cataract formation, increased muscle pains, increased musculoskeletal injuries, reduced blood levels of vitamin D, reduced levels of CoQ10, just to name a few side effects. Most importantly, statins may worsen and possibly cause diabetes. Nevertheless, in one of the ironies we have come to expect from modern medicine, the new AHA/ACC statin guidelines recommend statins for most diabetics.

I have nothing against statins. As a cardiologist, I prescribe statins when needed. What I am against is the indiscriminate use and abuse of not just statins but of all medications and an ever-increasing reliance of medications for everything that ails us.

I will continue to use statins as I do presently. In men younger than 75 years with coronary heart disease, including acute coronary syndrome, chest pain (angina), in those who have had heart surgery (bypass) or stents. People with hereditary hypercholesterolemia should also be considered for statin use. These are the groups that have been shown to get the most benefit from this class of drug. Their use in diabetic women and people with strokes (although current indications) is controversial.

Studies have shown that there is no reason or benefit for the elderly to be on long-term statin treatment. Low cholesterol levels in people over the age of 75, has been associated with decreased cognitive function. Maybe it’s because 25-30% of our brain is made up of cholesterol and cholesterol is essential for many metabolic functions including the production of hormones. However, there are even other medical “experts” who have suggested that it would be a good idea to start giving statins to children.

I find the reliance on medications that have potent side effects to be ongoing failure of the U.S. healthcare system, the costliest healthcare system in the world that only manages a quality and efficiency ranking of 46, behind Iran and ahead of Serbia. It is time to end the “pill for every ill” mentality of disease care synonymous with U.S. health care and make a radical shift back to using common sense and reasoning.

saladInstead of prescribing more drugs, we should be educating and stressing to the general public the importance and need for lifestyle and nutritional change first. The same inflammation and conditions that causes the elevated cholesterol levels that is treated with statins, are caused by and therefore can also be limited and controlled by diet and improved nutrition.

I find it interesting that the dietary advice of 40 years ago, which stressed the importance of eating minimally processed foods, avoidance of artificial sweeteners, selection of meats from organically raised animals and not industrially produced variety, went directly against the recommendations of the experts of that time.

I’ll continue to individualize treatment, educating my patients on the importance of food, exercise and lifestyle and prescribing drugs only when appropriate. I doubt future studies will find anything contradictory with this approach.

Jorge Bordenave, MD FACP ABIHM
Coral Gables, Florida (11-15-2013)
Integrative Cardiologist
Assistant Clinical Professor of Medicine, Herbert Wertheim College of Medicine FIU
Cardiology Lecturer IM and FP Residency Program

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How Nutrition Is the Cornerstone of Health in Integrative Medicine

Since Integrative Medicine takes a holistic approach to improving and maintaining health for the mind, body and soul, it would be appropriate to explore the role of nutrition in the whole body approach. Learning how to eat and for what types of health conditions nutrition can treat, it is essential to make the most of an Integrative Medicine approach to becoming and staying well. No matter what you are using Integrative Medicine to treat your body for your overall health, to manage inflammation, to support your body’s ability to manage its diabetes, to maintain heart health, and to promote a stable mood, through an Integrative Medicine approach, can have real results.

Eating for your overall health, perhaps the most important principle of Integrative Medicine, can be accomplished quite easily with some easy to follow principles. No matter what type of fruits and vegetables you eat, make sure they are in season, fresh and are grown without pesticides, antibiotics, hormones and other industrial agents. Eating as many colors and types of fruits and vegetables will ensure you are well protected against acute and chronic diseases. Whether fruits and vegetable are fresh or frozen, as long as you eat 8 to 10 servings per day, you will be served well.[i]

According to research, inflammation is becoming more widespread and is the culprit that causes many chronic and debilitating diseases. However, Integrative Medicine can help people reduce and manage their levels of inflammation, thereby reducing their chances of developing such serious diseases. Eating a balanced diet of protein, carbohydrates and fats is recommended. Variety really is the spice in your diet and is great to manage inflammation. Along with eating a wide variety of naturally colored fruits and vegetables and minimizing exposure to processed foods and toxins on and in foods, eating oily fish or taking fish oil supplements helps combat inflammation.[ii]

Integrative medicine, through its holistic approach, has a nutritional approach, along with medication, to help your body naturally manage its diabetes. With a 40-30-30 ratio of non-starch vegetables, lean protein and high fiber fruits and low-glycemic fruits respectively, the Integrative Medicine approach to supporting and not-stressing out your body while have a condition such as diabetes is very effective.[iii]

Eating to maintain your heart’s health is very essential because it provides blood which provides oxygen and nutrients to the rest of your body. Along with the theme of eating naturally through fruits, vegetables, fish, meat, nuts and oil (organic, when always possible), it is essential to make healthier choices when it comes to drinks, snacks and basic staples. Some examples of replacing poor heart healthy choices for better food choices includes: using flavorful herbs and spices instead of salt; replacing beer and spirits with red wine (in moderation of course); and replacing white bread and bagels with pita or sprouted bread.[iv]

Along with eating properly to maintain and support one’s organs and cardiovascular system, Integrative Medicine has not left out nutrition when it comes to supporting ideal mental health. Building on eating well through natural, organic and minimally processed foods, there are some specific recommendations to promote an even and healthy mood through nutrition. Specific suggestions include not skipping meals, eating foods to stabilize and minimize swings of blood sugar levels, increase consumption of omega-3 fatty acids, stay away from caffeine, minimize or avoid alcohol and ensure you have normal levels of necessary vitamins and minerals.[v]

As you can see, nutrition in the Integrative Medicine approach, is very integral to supporting both the physical body and the mind. Taking a serious approach to your nutrition will enable you to support your overall health. With advice from your Integrative Medicine practitioner, you will be able to maximize your health by becoming and staying well.

Dr. Jorge Bordenave practices Integrative, Preventive & Clinical Cardiology.
He is NOAA / UHMS Certified Dive Medical Examiner, Associate Clinical Professor of Medicine, FIU Medical College and Clinical Assistant Professor of Medicine, Nova Southeastern University.

Dr. Bordenave’s practice is located at:

 4908 SW 8 street, Coral Gables, Fl. 33134.

They are open Monday thru Friday 9am to 5pm.

Phone: 305.446.2444

Website: www.miamiintegrativemedicine.com

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[i] The University of Arizona. Resources: Top Ten Tips For a Healthy Diet.  http://integrativemedicine.arizona.edu/resources.html  Accessed November 15, 2012.

[ii] The University of Arizona. Resources: Anti-inflammatory Diet.   http://integrativemedicine.arizona.edu/resources.html  Accessed November 15, 2012.

[iii] The University of Arizona. Resources: Healthy Meals for Diabetics.   http://integrativemedicine.arizona.edu/resources.html  Accessed November 15, 2012.

[iv] The University of Arizona. Resources: Choosing Foods for Heart Health.   http://integrativemedicine.arizona.edu/resources.html  Accessed November 15, 2012.

[v] The University of Arizona. Resources:  Dietary Tips for Better  Mental Health.   http://integrativemedicine.arizona.edu/resources.html  Accessed November 15, 2012.