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Cardiologist Dr. Paul D. Thompson, MD, explains that the danger of leaving high cholesterol untreated varies from person to person. He shows how he weighs a patient's whole risk profile before recommending medication, and why he tells patients who want natural options that statins come from natural products.
Untreated High Cholesterol: Combined Risk Factors, Risk Calculators, and Natural Statins
Jump To Section
- Why the answer depends
- How risk factors add up
- Calculating heart attack risk
- Patient wishes and physician judgment
- Statins and natural products
- Full Transcript
Why the answer depends
The outcome of untreated high cholesterol depends on the individual, says cardiologist Dr. Paul D. Thompson, MD. Asked by Dr. Anton Titov, MD, what happens without treatment, he points to how high the cholesterol is and which other risk factors are present.
How risk factors add up
Combined risk factors raise risk more than each one alone, in Dr. Thompson's explanation. High cholesterol carries its own risk and diabetes carries its own risk, but together the risk goes way up. He puts it this way: it is not one and one equals two, but one and one equals three and four.
By contrast, he says a high cholesterol level with nothing else is not so bad. Smoking, a little bit of high blood pressure, diabetes, or obesity alongside high cholesterol make the whole situation worse, and the more of these factors a person has, the worse it gets.
Calculating heart attack risk
Risk calculation is how Dr. Thompson and his colleagues decide how dangerous a patient's cholesterol is. They ask whether lowering it would help the person live longer or have fewer heart attacks. He says he can take age, blood pressure, cholesterol level, diabetes, and the good cholesterol level into a formula that gives a percentage.
He contrasts a low and a high result. With a 1% chance of a heart attack in the next 10 years, he says they probably would not want to treat. With a 20% chance, nobody is calling an ambulance yet, but they may have to in the future, and he would start that person on cholesterol-lowering medication as soon as he possibly could.
Patient wishes and physician judgment
Patient involvement is something Dr. Thompson encourages. He says many patients want to decide what will happen to them, and that patients know themselves. On the other hand, he notes that most patients did not go to medical school and most ignore these risk calculations. He says that he, like most physicians, does what he thinks is the best thing for the patient.
Statins and natural products
Statins, which Dr. Thompson calls "the best way to lower your cholesterol levels," are common in natural products, he explains. He mentions mushrooms as one example. Red yeast rice is sold for lowering cholesterol, he adds, because it contains a lot of lovastatin.
For patients who only want something natural, he points out that statins are derived from natural products. He recalls telling patients that lovastatin was made for Merck by yeast in vats. Statins are chemically manufactured now, he says, but they are derived from natural products.
Full Transcript
Dr. Anton Titov, MD: What happens if I don't treat high cholesterol?
Dr. Paul D. Thompson, MD: What happens if you do not treat high cholesterol depends. It depends on how high the cholesterol is and on the other risk factors. So let us talk about this.
Dr. Paul D. Thompson, MD: If you have a high cholesterol, here is your risk. If you have diabetes, here is your risk. If you have diabetes and high cholesterol, your risk goes way up.
Dr. Paul D. Thompson, MD: It is not one and one equals two. It is one and one equals three and four. So if you have a high cholesterol level and nothing else, that is not so bad.
Dr. Paul D. Thompson, MD: But if you have a high cholesterol level and diabetes, or a high cholesterol and you smoke, or a high cholesterol level and you have a little bit of blood pressure, etc., etc. The more other risk factors you have, obesity, all that sort of stuff, the more other risk factors you have, the worse it makes your whole situation. So what happens to you depends on your cholesterol level, it also depends on the other risk factors, and it also depends on that thing called apolipoprotein A.
Dr. Paul D. Thompson, MD: Now, I talked about that. Apolipoprotein A is a type of bad cholesterol that takes any cholesterol level you have and makes it worse. What I do when I see patients, and what all of us who do this sort of stuff do: when you see a patient, you try to decide, how dangerous is this person?
Dr. Paul D. Thompson, MD: How dangerous is their cholesterol? Is it valuable to them to lower their cholesterol? Will they live longer?
Dr. Paul D. Thompson, MD: Will they have fewer heart attacks? That is what we do, and we have risk factor calculations. I can take your age, your blood pressure, your cholesterol level, your diabetes level, your good cholesterol level, put it into a little formula, and we can come out with a percent.
Dr. Paul D. Thompson, MD: You have got a 1% chance of having a heart attack in the next 10 years. Well, probably we do not want to treat you. Or you could have a 20% chance of having a heart attack in the next 10 years.
Dr. Paul D. Thompson, MD: That person, we are not going to call the ambulance right yet, but we may have to in the future. So that person I am going to get on cholesterol-lowering medications as soon as I possibly can take care of it. So what happens to you?
Dr. Paul D. Thompson, MD: It depends. It depends on all the risk factors. Now, that is one of the important points I always tell patients.
Dr. Paul D. Thompson, MD: A lot of patients want to decide what is going to happen to them, and I encourage that. Patients know themselves, but on the other hand, most patients did not go to medical school, and most patients ignore these sorts of calculations. What I as a clinician, a physician, and what most physicians do is absolutely do what we think is the best thing for you.
Dr. Paul D. Thompson, MD: Now, statins, which are the best way to lower your cholesterol levels, are actually quite common in natural products. For example, you know those umbrella mushrooms that you used to get at the salad bar before COVID got rid of all salad bars? Umbrella mushrooms by weight are about 14% lovastatin.
Dr. Paul D. Thompson, MD: Lovastatin, statins are natural in the environment. There is something called red yeast rice. Red yeast rice is sold as a cholesterol-lowering agent.
Dr. Paul D. Thompson, MD: You know why it is sold as a cholesterol-lowering agent? Because it has a lot of lovastatin in it. So when patients say to me, "Oh, I do not want to do anything if it is not natural"...
Dr. Paul D. Thompson, MD: So statins actually are derivatives of very natural products. I used to tell my patients that when Merck was making lovastatin, which is also in mushrooms and other places, it is actually made in vats by yeast. I used to say that lovastatin is a natural product.
Dr. Paul D. Thompson, MD: It is made by a lot of yeast in a vat working for Merck. So, yes, statins are natural products, believe it or not. Now, they are chemically manufactured now, but they are derived from natural products.