Introduction How many of these questions about statin drugs, the top-selling drugs for lowering elevated levels of cholesterol and C-reactive protein, can you answer? * Do I need to lower my cholesterol level? * Do I need to take a statin drug? * Which statin is best for me? * What is the right dose for me? * What are the side effects and how can I avoid them? * Are there long-term risks with statins? * If side effects occur, what can I do? * Are there alternative methods I can use instead of statins? * Are there other things I can do to preserve cardiovascular health? * What is the best heart-healthy diet for me: low-carb or low-fat? * How important is exercise, and how much is necessary? * How can I save 50 percent or more off the high cost of statin drugs? These are important questions for the 100 million Americans with elevated cholesterol. These questions are even more important for the 20 million Americans who take statin medications--Lipitor, Zocor, Pravachol, Mevacor, Lescol, or Crestor--and for the 25 million more who are slated to be taking statins soon. Taking statins is simple, right? Elevated cholesterol = statins. Yet statins are potent drugs that can cause serious side effects. Are doctors prescribing statins with the care needed to use them effectively and safely? Are doctors carefully selecting the right statin at the right dose for people as individuals? Are doctors thinking about how to reduce people''s risks of side effects and long-term toxicities? Are doctors offering you and others ways for keeping statin costs as low as possible? Are they informing you about other safer, proven-effective, less expensive alternatives? For many statin users today, the answer is no, no, no, no, and no. Statins help millions of people, but like all drugs, they can also cause harm. Medicine''s most respected pharmacology reference, Goodman and Gilman''s Pharmacological Basis of Therapeutics, states: "Any drug, no matter how trivial its therapeutic actions, has the potential to do harm." Statins'' effects are not trivial.

Statins are very powerful chemicals that exert effects in every cell of your body. Many of these effects are good, but some can be bad. How can you maximize the benefits while minimizing the risks? Just as when buying a car or choosing a college for your child, the more information you have, the better your chances are of doing it right. What information do you need to take statins safely and effectively? That is what this book ­provides. Most doctors will simply tell you that statins are safe and hand you a prescription. Yet statins have many common side effects that cause physical discomfort or mental impairment in millions of people. Sixty to seventy-five percent of people started on statins stop taking them. The average patient lasts only eight months on statins.

Why? Side effects. Inadequate effects. Cost. These are the issues that come up again and again when I give seminars, speak with people, or read their letters. These are the problems that mainstream medicine has not learned to overcome. But they can be overcome--indeed, they can be prevented--which is why I have written What You Must Know About Statin Drugs & Their Natural Alternatives . I am pro-medication and pro-statins, but my first responsibility, like all doctors, is to "Do No Harm." Sometimes doctors cannot avoid doing harm, but this is not the case with statin drugs.

Statin risks can be dramatically reduced with a treatment model that emphasizes precision and safety, as this book will describe. Statins can be very effective drugs--if given for the right reasons to the right persons at the right doses with the right treatment goals. Unfortunately, millions of people are prescribed statin doses that are too strong for their treatment goals, provoking side effects. Fifteen to forty-two percent of people given statins get side effects. That''s 7 to 15 million people. These side effects may be considered minor by doctors, but abdominal discomfort, muscle or joint pain, or memory impairment are not minor to you. And some statin side effects are not minor even to doctors: severe muscle pain or weakness, nerve injuries (some permanent), acute muscle breakdown, kidney and liver irritation or toxicity, and rarely, death. Moreover, when 60 percent to 75 percent of people needing statins quit treatment, no one benefits.

The long-term consequences of premature heart attacks and strokes harm not only patients and their families, but remain a costly, unsolved problem for hospitals, healthcare systems, insurers, and even the pharmaceutical industry and U.S. Food and Drug Administration. The good news is that most of these problems are preventable, but only if you and your doctor know how. This is explained in Chapter 1, Avoiding Statin Overtreatment or Undertreatment: The Precision-Prescribing, Safety-First Method. The precision-prescribing, safety-first method will allow you to maximize the benefits of statins while minimizing the risks. The most important question, of course, is whether you need statin therapy at all and, if so, how much? Chapter 2, How Much Cholesterol Reduction Do You Really Need?, answers these questions. Chapter 2 briefly explains the role of cholesterol, low density and high density-cholesterol (LDL-C, HDL-C), and C-reactive protein (CRP) on artery-clogging atherosclerosis and cardiac disease.

Because of confusion about treatment goals, many doctors prescribe statin doses that are overly aggressive for people''s requirements. This excessive treatment brings little extra benefit in exchange for significantly increased risks. It''s not a good deal. That is why it is important for you and your doctor to know how much cholesterol-lowering is really beneficial, so treatment can be tailored to your needs and goals. Chapter 2 also tells you about five other risk factors that are often overlooked. These risk factors explain why half of the people who get heart attacks have normal cholesterol levels, so you want to know about them. Chapter 3, The Right Statin at the Right Dose, explains why the standard initial doses of statins are unnecessarily strong for millions of people. Because of the omission of important information from package inserts and the Physicians'' Desk Reference (PDR), many doctors, not intentionally, overshoot the mark when prescribing statins, giving patients very potent doses when mild ones would do.

Chapter 3 describes who is most likely to benefit from the precision-prescribing method and what your goals should be when first starting treatment. Chapter 4, Low Dose Statins--The Evidence, provides several strategies for choosing the right statin at the right dose for you. Chapter 4 presents the scientific evidence on the lower, safer, proven effective doses of each statin. It''s not enough for me to say that lower statin doses work. Medical treatment should be based on scientific proof whenever possible, and that is what this chapter provides. Chapter 5, Why Do People Respond so Differently to Statin Drugs?, explains why different people respond so differently to statin drugs. It explains why some people need strong statin doses while others need just a little, and how to identify each without causing harm. Chapter 6, Women and Seniors-- Special Considerations with Statin Drugs, focuses on two groups that require extra attention and information in order to use statins effectively and safely.

Few patients or their doctors know about the issues discussed in these chapters, but they are essential for optimal care with minimal risk. Chapter 7, Effective Strategies for Dealing with Side Effects and Other Problems with Statins, answers the many questions that people sustaining statin side effects have asked me. Unfortunately, the medical system isn''t very good about identifying or handling side effects, so I have divided Chapter 7 into seven sections that identify specific problems and offer practical solutions. Many people do not like taking prescription drugs. If you''re one of them, Chapter 8, Effective Alternative Therapies for Reducing Cholesterol and Other Risk Factors, is for you. There are several proven-effective alternative therapies worthy of consideration that cost much less than brand-name statins. Because making the right decisions about reducing cholesterol and other risk factors will have a major impact on your long-term health, I always recommend that you and your doctor make decisions about these alternative methods together. Whether you take a statin or an alternative therapy or do nothing at all, there are four nutrients that everyone should consider for preventing cardiovascular disease.

Chapter 9, Essential Nutrients for Cardiovascular Health, describes them and their importance: omega-3 fatty acids (fish oils), coenzyme Q10, folic acid, and magnesium. Most people are sorely deficient in these nutrients, whose vital roles in maintaining a healthy heart and vascular system are backed by extensive scientific study. Nutrition, of course, is also a big part of the equation for heart health. Yet there is so much confusion today.