The Importance of a Healthy Lifestyle

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The MD Magazine Peer Exchange “Amassing the Clinical Evidence for Optimized Dyslipidemia Management: Vitamin D, Long-Term Statin Outcomes, and PCSK9 Inhibition” features expert insight and analysis of the latest information on managing hypertension and hyperlipidemia, and in-depth discussion on the use of PCSK9 inhibitors in practice.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Christie Ballantyne, MD, Co-director of the Lipid Metabolism and Atherosclerosis Clinic at The Methodist Hospital, Director of the Center for Cardiovascular Disease Prevention at the Methodist DeBakey Heart Center, and the Chief of Cardiology at Baylor College of Medicine
• Keith C. Ferdinand, MD, Immediate Past Chair of the National Forum for Heart Disease and Stroke Prevention, and Professor of Clinical Medicine at the Heart and Vascular Institute at Tulane University School of Medicine
• Jennifer G. Robinson, MD, MPH, Professor in the Departments of Epidemiology & Medicine and Director of the Prevention Intervention Center, Department of Epidemiology at the College of Public Health, University of Iowa
• Karol E. Watson, MD, PhD, Professor of Medicine and Cardiology, Co-director of the UCLA Program in Preventive Cardiology, and Director of the UCLA Barbra Streisand Women’s Heart Health Program

“Lifestyle has to be our foundation. We keep forgetting that,” said Watson. She also said that if we can get the entire country on a low saturated fat diet, then that needs to be our goal. It is also practical to “go to where people are,” said Robinson, and “most average Americans have a lot of atherosclerosis.” Therefore, they need to keep working on making healthy lifestyle changes, but also, many of them will benefit from medication.

According to Ballantyne, many patients are hesitant about initiating statin therapy for fear of increasing their risk of diabetes. But data have shown that “if you were to walk 30 minutes 5 or 6 times a week and lose 5% to 7% of body weight,… they can reduce the chance of diabetes by about two thirds,” so lifestyle modifications can be emphasized when these fears surface. Watson added that statin therapy perhaps unmasks diabetes rather than causes it, as the people who develop diabetes while on statins typically were already prediabetic with metabolic syndrome, and so the 2- to 4-mg/dL glucose increase tips the person over the edge.

The panel agreed though, that the one drug a person with diabetes, who now has a diabetic’s cardiovascular risk profile, should be taking is a statin. Once a patient is on the threshold of diabetes, there is already extensive atherosclerosis, and statin therapy is necessary in addition to a healthier lifestyle.