♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Welcome my friends to the Bob and Brad podcast.
Produced by Bob and Brad.
The two most famous physical therapists on the internet.
- In your opinion, of course.
- In our opinion, of course.
I'm Brad.
I'm exactly one half of the Bob and Brad team.
And we're fortunate enough today
to have Chris The Pharmacist with us.
- Hey, guys.
- And today what we're going to cover is statins
for high cholesterol.
Which helps prevent strokes, heart attacks.
And we're going to go into the side effects.
And the safe use of these drugs is very common.
Including, let me get the pronunciation, Adervastin?
- Atorvastatin.
Yeah, anyways, he did a nice job with pronouncing it.
So this video is going to give you all the information
about statins.
Things that if you're starting them
or if someone that your loved one is starting them
and you want all the information you can.
That maybe you forgot to ask the doctor or the pharmacist
or you just didn't have enough time because life is busy.
This'll fill you in.
- Yep, we're going to do our best on that.
- All right.
So, statins for high cholesterol.
What are we talking about
and what are these drugs doing for us?
- Well, a statin, basically people come into a doctor
and whether they've had a heart attack, a stroke
or maybe they've just had some routine lab work.
And all of a sudden they've seen repeated lab work
where the cholesterol levels started creeping up.
- So they get the blood sample and they measured your LDLs.
- Yeah, they do a whole lipid panel.
So you're going to see your LDL, your HDL,
probably your apolipoprotein A, a your triglycerides.
They're going to look at-
- And the doctor looks at it-
- Very scientifically.
- And decides whether or not you're a candidate for-
- For drug A, B, or C.
- Right.
So statins is actually a broad term for,
how many drugs fit under statins?
- There's several.
You're going to have the very first one that came out
was lovastatin.
And then they had simvastatin,
which was both made by Merck Pharmaceuticals.
And then atorvastatin hit the market.
And that's the largest in the last 25 years, I think.
That's the largest selling drug
of the last 25 years, is atorvastatin.
- In the States?
United States or worldwide?
- As far as I know, United States.
- Okay.
- So, it's like 94 billion in sales.
- Wow.
- That's a lot.
- So that's all people being treated for cholesterol issues?
- Yes.
- Which then creates problems with your vessels, your heart-
- Well, it's going to protect them.
It's cardioprotective.
So basically it's an insurance policy
to protect you against stroke or heart attack.
- Yeah, so your arteries don't clog up.
- Exactly.
And some people, just to make it overly simply,
it's not like taking Drano.
But it's going to help to keep your arteries clear.
It works in a variety of different things.
And we'll pick on atorvastatin first.
Because I would say it's probably the most versatile.
Rosuvastatin, Crestor, is probably the most potent.
But atorvastatin, not only does it lower
the cholesterol well-
- So this a specific drug that a doctor may prescribe?
- Yeah.
They're going to make some very specific choices
as to what they need done.
Because not only do statins help to reduce cholesterol
but they also are naturally anti-inflammatory.
Which is one of the added benefits of it
for why it helps to keep those arteries clear.
So let's say it's a bad case scenario,
where you had a heart attack or a stroke,
and you were in the ER.
They're going to probably plop you on a high dose statin
because they want to maximize
the anti-inflammatory effects of it.
And more importantly, the lipid profile aspects of it.
To try and make sure that we don't have this event
occur again.
- Sure.
- So it's a very touchy time for patients
when they're in a crisis situation.
As we all know, heart disease is the number one killer
for all of us.
And so, when we use drugs like statins,
or atorvastatin in this particular case,
we want to do that to keep them alive and keep them well.
These are pretty much, unless we have better science,
these are drugs that we typically, if we're placed on them,
probably rest of your life kind of things.
- So, I don't want to interrupt, but I do.
Because I'm thinking,
"Well, if this is a problem with the arteries being clogged,
isn't that very directed to our diet?"
"And can't diet changes help a lot?"
- Dietary changes are going to be absolutely massive
in this whole healing effort.
And even, let's say you're just a patient
that your doctor saw a trend that your triglycerides
and cholesterol were raising over time.
Or you were the acute patient
that the heart attack or a stroke.
Statins are going to be part of that mix.
But more importantly than any drug
we could put in your body, the foundation of health
is going to be eating well and exercising.
So at some point,
if you're a heart attack or a stroke victim,
there's going to be a cardiac rehab portion
of that equation.
- Sure.
- To teach you to get into better lifestyle habits
to stay healthy.
But most importantly is nutrition.
But the problem with cholesterol is it's a genetic problem.
You can drink cholesterol by the gallon.
It's a big fat greasy molecule
that you don't generally absorb too much.
So your body's making too much cholesterol in most cases.
And so statins block at an enzyme,
HMG-CoA Reductase Inhibitor.
That's what they are.
That's what statins-
(laughing)
I know, it's a mouthful.
But it blocks that particular enzyme.
And there's a big series of steps
that go on to make cholesterol,
but it blocks it at that point.
And that's why it helps to keep those arteries and vessels
clear of cholesterol and plaque.
And so what we want to do,
and all of these statins, to one varying degree or other,
not only do they help to lower your cholesterol,
but they generally bring up your HDL.
Your good, your high density lipoprotein,
which is your good cholesterol.
- So, if you have this,
either you've had a stroke or a heart attack, you survived,
you're going to probably be on this medication.
Or, you see that rise and it's a preventative thing,
so you don't have a heart attack or stroke.
- Exactly.
It's like buying car insurance.
- Sure.
- You hope you don't have the accident.
- Right, exactly.
So you're going to change your diet,
you're going to get more exercise,
and the doctor's probably going to suggest this as well.
- Yes.
- I'm the kind of person
and there might be other people like this-
- There's a lot.
- I don't want to take these meds.
Maybe I can just do it exercise and diet.
So is that a possibility?
- It is a possibility.
And if your doctor, let's say you're the patient
that your doctor follows every year,
and you go in and you're a good faithful patient,
and they keep looking at your blood work.
And let's say they see it creeping up and up.
Then it might be the time to say,
"Okay, Brad, I see that your cholesterol levels
are now in medium two hundreds.
You're sitting around two 50.
I think it's about time we start to make a change
so we can lower your risk for cardiovascular events."
And so you're like,
"Oh yeah, I've gotten off my exercise program
and I've been probably eating out
a little bit more than I should."
Well, so you can definitely make the,
"I'm going to make a decision."
"I'm going to start walking."
"I'm going to start running."
"I'm going to start biking."
"I'm gonna do more yard work."
You have to find a reason to be more active.
Swim, it doesn't matter, you need to do something.
You got to move that body.
And you want to move for at least 30 minutes a day,
at least five days of the week.
So you're talking about 150 minutes a week.
You want to dedicate to that.
But you still have to put the right food in the machine too
to make sure that we're not overly doing it.
And your can doctor say,
"Okay, I agree with your plan, Brad."
"I like your idea."
"We're going to try and do these lifestyle changes
and dietary changes."
"We'll revisit this test in about six months."
And then they'll come in, reach out.
And if you see the trend going in the right direction,
God love you.
We're going to keep you off of drugs.
But not a lot of us get that lucky.
And there's a genetic disposition
to kicking out too much cholesterol.
And particularly the LDL, and maybe our HDL,
isn't as high as we need it to be.
Because that's kind of your scrubber.
That's the one that kind of helps to keep plaque
from building up.
So these drugs, in particular, actually raise your HDL
that helps is another protective effect
besides the anti-inflammatory effects.
So there's a lot of good things
that happen with this for patients.
And so that's important to realize.
And so if you're resistant to wanting to take medication,
a lot of people go,
"Gosh, statins."
"I've heard so many negative things about statins."
The incidents of side effects on statins, for the most part,
is about 1%.
So, 99 people tolerate these drugs unbelievably well.
One person has a problem,
when we're talking about a hundred people.
And so those side effects can range from a variety
of different things.
Doctors are watching for these very closely.
They're watching your liver function.
In three months, they're going to take a blood test
to see that it's making sure it's doing its job.
And making sure your body is processing it properly.
They're going to be looking at your renal functioning.
Because, let's say, you're someone
who's got some kidney problems or something
or there's a genetic issue.
Or a variety of different reasons.
- And that's just a blood test?
- Yeah, blood test.
So they'll take care of all those things.
Your doctor is doing all of this.
All the things that they don't tell you about.
So they're doing lab work.
And a lot of times now if you have a smartphone,
you can see all your lab work.
It's pretty slick.
So it's nice to be informed.
And I really would tell you to get informed
about your numbers.
Because that's something that you and your doctor
can work with to make informed choices
to see what the best course is for you.
Because not all statins are created equal.
And we picked atorvastatin
because it's probably the most versatile of the bunch.
But let's say you need a little bit more HDL developed,
well maybe rosuvastatin is a better choice.
And let's say, here's one of the reasons
we're going to talk about is grapefruit.
- Yeah, my favorite fruit.
I am convinced.
I don't care what the research says.
I don't know if there is any.
But I know I eat grapefruit every day
from November until April and during the season.
I've been doing it for about almost 10 years.
And since I've been doing that, I have never had a cold.
I start one, like a scratchy throat, blah, blah, blah.
But it never gets bad!
And I don't know if it's because of the grapefruit
but I'm thinking I want to continue it.
I love it.
I think it's good for me.
I'm not going to stop
just because a doctor says I need statins.
(laughing)
- And you know what, that's okay.
Because actually with grapefruit,
there's really three statins we'd tell you to avoid it with.
It'd be lovastatin, atorvastatin, and simvastatin.
All the other statins, so fluvastatin, rosuvastatin,
pravastatin.
- So I can still enjoy my grapefruit?
- Yes.
So that's not off the table for people.
And even some physicians and some studies support
that even it's the timing of eating grapefruit
with your statin.
And I would tell you,
that the reason that we are so concerned
about the interaction with grapefruit with statins,
is it going to increase the risk for muscle problems?
Myopathies?
- So that's muscle pain?
- Muscle pain and weakness.
Rhabdomyolysis is the worst case scenario
and that can actually even be fatal.
- So that's a side effect or possible side effect?
- It could be a possible side effect
of combining statins with grapefruit.
Or even statins in and of themselves,
can cause it in very rare circumstances.
But it's a big deal.
Because basically, what it causes,
is program muscle cell death.
And basically what happens is those muscle cells die off.
And then they kind of ooze into your body
and then it has to get metabolized out,
so it goes through your kidney
and can cause acute renal failure.
So it's a big deal.
Like I said, it's very rare.
But when you come to your doctor or pharmacist,
watch out for unusual muscle pains or weakness.
It's not common.
But it's one thing to be a little stiff or sore
if you're raking your leaves
or you're shoveling your driveway.
And you can have some muscle pain
because maybe you haven't done that motion for awhile.
But this kind of comes out of left field
and you're just kind of saying,
"Man, I'm just achy and weak."
"I don't understand what's going on."
And that's a time when you really want to talk
to your doctor.
And they're going to take a quick blood test
to make sure it's not overworking the liver.
And that doesn't mean that,
you heard me say,
that these are kind of rest of your life alternatives.
There are things that you can take besides that,
if you can't tolerate statins.
But for the most part, usually just switching the statin
from a different form to a different one.
Because they have different metabolic pathways
in your liver.
So, and that's why grapefruit is tolerable
with some but not others.
And so we want to make sure that,
and your doctor is acutely looking for these things.
But this is the time to not,
"I'm going to just man up and take this."
"I'll be better in a couple of days."
If it's not getting better,
this is progressively getting worse,
then you're going to know.
You really want to speak up.
So don't be shy in this particular case.
Talk to your doctor.
Rare but serious.
So it's a big deal.
But the reality of it is,
is that when we're going to try and take care of our hearts,
it starts with the foundation.
Sleep, exercise, and diet.
Those are our three pillars
that we always talk about as far as that.
So you want to make sure you're getting your rest
because that's recovery.
And you want to make sure that you're eating well.
So even if you have to take these statins,
even if you've had a heart attack,
even if you had a stroke,
we need to find ways to do these things
and do whatever things our bodies
will allow you to be able to do.
So that we can live the best way we can.
- And did we talk about how many people
in the United States are on statins or roughly?
Do you have any stats on that?
- I actually don't have a straight stat,
but it's millions of patients are taking these things.
Atorvastatin is by far and away the number one statin
that's being prescribed.
Rosuvastatin is used quite regularly.
- Typically, what age do we see it more,
in the fifties, sixties, seventies?
- You'll see it as young as even in the thirties,
if there's a genetic predisposition
towards cardiovascular disease.
If you have heart disease in your family,
and your doctor,
and the doctors are excellent at screening for this now,
they look at everything.
When you go in for a physical these days,
they usually have you fill out a 10,
it takes a 10 minutes to fill it out.
And they look at that very critically,
before you even walk into the room,
to see what your cardiovascular risk assessment is.
They actually do that at a younger age now.
And they're finding
that they're getting some excellent results
by either starting early statin therapy.
Or even just talking about,
"Hey, you got to get a better lifestyle."
"We need you exercising more."
"We need you eating better."
"If you want to stay off these drugs,
we need to start there."
That's your foundation.
So that's critical.
Because we hopefully can keep you off of the medications.
But sometimes we can't.
And so if we can't, we're going to try and make sure
that you get the best choice.
And the big thing is don't be shy, guys.
Talk to your doctors, have a good open dialogue.
Your doctor just wants to help.
They're there for you to help you live a better life.
They're not just trying to collect a paycheck.
They are there beyond that.
They're doing it for you.
And so, sometimes things don't work out of the gate.
So that conversation is absolutely critical.
So you can live the best way that you possibly can.
- Yeah.
And that's the other thing,
with the information in this video,
may give you information to come up with good questions
that are direct to the point
and help make it more efficient.
Because obviously the doctors don't have,
unfortunately, a lot of time with each patient.
- They don't.
And I guarantee every doctor on the planet
would tell you,
"Yeah, I wish I could spend way more time
with my patients."
But it's just their job, their drive,
the things that are driving the bus for them in their world,
are forcing them to try and make
the best possible decisions.
In oftentimes 15 to 30 minutes.
And sometimes that's hard.
There's a lot to talk about.
Especially if you've come in for your first visit
post heart attack or post stroke,
there's a lot to discuss.
And so the other thing too, is an appointment.
Always write your questions down before you see your doctor.
I think that's something that'll help out.
So just make a list.
I'm not tolerating this drug well.
I have these side-effects.
I'm either tired, I'm dizzy.
I feel a little achy.
Make sure you write those down
so they can address them one by one.
Because that'll help you to streamline the conversation too.
- Because so many times you'll go in
and you come back and say,
"I forgot to ask him or her this question."
- Exactly.
- And the other thing,
I think a lot of people aren't aware of is,
particularly if it's a medication problem,
when you go to the pharmacist,
ask your pharmacist questions.
As you can see, I always think
that Chris could be a really good doctor.
(laughing)
You've got everything for it.
There's no doubt about it.
But the pharmacist has a lot of information
that could be helpful with that.
Just like we're talking about.
- With respect to the drugs,
use your local pharmacist.
They're going to help you to get what you need done.
They can answer those questions quickly and easily
and steer you in the right direction.
They're going to point you in the right direction, guys.
They're there for you.
We're oftentimes an untapped resource.
So feel free to use us.
Go to your neighborhood pharmacy,
just strike up a conversation, develop a relationship.
Because those relationships are going to help you
to live a better life,
so that you can be a better version of yourself.
- And how long have you been at the store
you're at right now?
- 16 years.
- 16 years at the same store.
And you probably know people just from work.
- I know one or two people.
(laughing)
- They walk in, they say, "Hi, Chris."
You know their name and if they have questions.
- Oh yeah, I know their kids.
I know their grandkids now.
I've been doing it for about 26 years.
So it's nice.
- So very good.
I hope this makes you feel better about statins,
a little more understanding with it.
And what we're gonna do is go get something good to eat
and get some exercise.
Huh, Chris?
- It sounds like a good plan to me.
Have a good day, guys.
Thank you.