My doctor is suggesting statins to reduce my risk factors for cardiovascular disease. What are my other options?

Optimal statin therapy can only reduce your risk by 34 percent or so, leaving you with considerable residual risk. Not only are statins not the complete solution, they also have serious side effect risks including liver and muscle damage, neuropathy, cognitive loss, and sexual dysfunction. And they are associated with an increased risk of diabetes.

Optimal management of cardiovascular risk, and health in general, demands serious attention to lifestyle. I prefer to start with that as a foundation for overall health goals. We can always add medications if we can’t achieve those goals with the basics.

Focus on these four areas to develop/maintain a healthy lifestyle.


Forty-five to 60 minutes per day of exercise is perhaps the most important health practice for someone with hypertension, diabetes, and heart disease. It has the combined benefits of reducing blood pressure, raising HDL (good) cholesterol, maintaining ideal body weight, and improving insulin sensitivity. Hypertension, adult onset diabetes, vascular disease/unhealthy cholesterol levels, and obesity are all part of the insulin resistant syndrome. Exercise is the most effective remedy for that syndrome. Regular exercise also helps maintain healthy levels of an enzyme called superoxide dismutase that protects the body from oxidative damage.


Nutrition is a close second in importance. Focus on foods that contain healthy fats, especially omega-3 fatty acids found in marine foods, walnuts, flaxseed, and eggs. Having a proper dietary ratio (1:10) of omega-3 to omega-6 fatty acids helps to minimize destructive inflammatory processes in the body that contribute to vascular disease risk. Avoid trans fats and some saturated fats, but a true low-fat diet is not healthy for diabetes or heart disease.

Some of our best food sources of protein and healthy fats (dairy, meat, fish, eggs) also may contain cholesterol. Dietary cholesterol is really not a problem if you also choose foods with that meal that are high in soluble fiber or are fortified with plant sterols to block cholesterol absorption. Good soluble fiber sources include oats, barley, flaxseeds, beans, and fruits with pectin (grapes, apples, pears, apricots). Plant sterols are found in all plant foods, but not in the concentration needed to block cholesterol absorption (400-800mg/meal). Today there are many plant sterol-fortified foods available, such as orange juice and milk, making them easily added to any meal. (See Consuming soluble fiber with a meal is a bonus for those with diabetes because it lowers the net glycemic index of the entire meal, decreasing the blood levels of insulin required for energy metabolism.

It’s also essential to regularly consume antioxidant-rich foods such as fruits, vegetables, and whole grains. Berries, beans, and red palm oil deserve special mention, and even dark chocolate gets a nod. Antioxidants help prevent cancer and slow the aging process and are especially important in preventing heart disease, since LDL cholesterol must be oxidized before it can be deposited in arterial walls to make plaque. A modest amount of alcohol (two drinks a day) is also associated with better heart health. Red wine has the added benefit of the antioxidant resveratrol.

3//Weight Maintenance

Ideal weight maintenance is extremely important since obesity contributes to your risk of diabetes, hypertension, and heart disease. Matching caloric intake with energy needs is just as vital as regular exercise. The fat that adds to the waistline is especially bad for diabetes management and contributes to insulin resistance.

4//Stress Management

Stress management is important for heart disease prevention. The hormones released in the body under chronic stress contribute to hypertension by tightening blood vessels, to diabetes by raising blood sugar, and to heart disease by increasing the workload on the heart (high blood pressure) and increasing irritability and rhythm problems in heart muscle. Chronic stress also impairs the immune system, increasing the likelihood of infections, which can complicate diabetes and heart disease. And poor stress management may lead to secondary bad habits that undermine our health such as overeating or drinking, or, worse yet, smoking. Regular exercise is a wonderful stress reducer and releases the positive “feel good” hormones, endorphins.

Each of these lifestyle management areas must be individualized to suit a person’s unique preferences and liabilities. A concerted trial of at least three to six months is needed to assess the potential for these basic interventions to meet health goals. Most people who take these steps seriously will avoid or delay the need for nearly all medications and will improve their overall health and quality of life.


Joseph Keenan, MD, is a researcher in preventitive cardiology with a special interest in the use of nutrition and nutritional supplements in the reduction of cardiovascular disease risk. Dr. Keenan has been awarded over $5 million in research grants and has published more than 50 scientific articles dealing with his research.