MedEvidence! Truth Behind the Data

Cardiologist Breaks Down Myths Around Statins and Grapefruit

• Dr. Michael Koren, Kevin Geddings • Episode 361

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Dr. Michael Koren joins Kevin Geddings to review some possibly outdated information on modern statin bottles. Kevin reveals that he dutifully takes his statin at night and avoids grapefruit, but cardiologist Michael Koren, MD, gives updated advice. The doctor states that rosuvastatin, a newer statin, is long-acting, and that taking it at night may not be as necessary as in earlier statin types.  The doctor then states that rosuvastatin was also developed to avoid the interactions between statins and grapefruit, and that small amounts of grapefruit may be ok for Kevin to consume.

PLEASE NOTE: The information provided in this podcast is for general educational, scientific, and informational purposes only and is not intended as, and should not be treated as, medical or other professional advice for any particular individual or individuals.  Consult with your doctor before makng alterations to medicines or foods that may interact with them.

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Have a question for Dr. Koren? Email him at askDrKoren@MedEvidence.com

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Music: Storyblocks - Corporate Inspired

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Announcer:

Welcome to the Med Evidence Monday Minutes Radio Show, hosted by Kevin Gedding WSOS St. Augustine Radio and powered by ENCORE Research Group. Each Monday morning, Dr. Michael Koren calls in to bring you the latest medical updates and insightful discussions. MedEvidence is where we help you navigate the real truth behind medical research with Both a clinical and research perspective. So sit back, relax, and get ready to learn about the truth behind the data in medicine and healthcare. This is MedEvidence!

Kevin Geddings:

Dr. Michael Koren joinging us live today. We appreciate him he's a medical doctor, of course, cardiologists, a research scientist. Big part of our family here at WSOS, and of course runs the show at ENCORE Research Group where you can involve yourself, get involved in clinical research. Right there in the Weststone building next door to U.F. Flagler Hospital. Lots of stuff going on. And yeah, I was talking with Dr. Koren about how on my bottle for the statin that I take every night, it says, of course, I should take it at night before I go to bed, not in the morning. That's number one. But number two, I should absolutely not consume grapefruit juice. Why is that, Dr. Koren?

Dr. Michael Koren:

Well, Kevin, as we like to say, MedEvidence, everything you hear isn't necessarily true. Okay. So actually both of those statements are actually inaccurate.

Kevin Geddings:

Wow.

Dr. Michael Koren:

So let's break them down because this is actually what we do with patients in research, is we break down all these myths and misperceptions and help people understand the truth behind the data, as we like to say. So let me can I ask you what statin you're taking?

Kevin Geddings:

R uh rosovostatin? Rosastatin? That's not sort of.

Dr. Michael Koren:

Okay, Rosuvastatin.

Kevin Geddings:

Yeah, thank you.

Dr. Michael Koren:

Rosuvastatin is was known as Crestor. You probably on a generic uh version of it.

Kevin Geddings:

Okay.

Dr. Michael Koren:

And actually you can take rosuvastatin anytime day or night.

Kevin Geddings:

Really?

Dr. Michael Koren:

Because yeah, rosuvastatin is a long acting statin. And some of the earlier statins, most notably simvastatin or Zocor, was a short-acting drug that really needed to be taken at night. So it could actually have certain effects on the liver, which in turn lowered cholesterol. But the newer statins, like a torvastatin, Lipitor, or rosuvastatin, really can be taken anytime. So that's one of those holdovers that's not necessarily true for your specific product, but that has been sort of a legacy because of certain products in the class. But I can assure you that rosuvastatin will work day or night. So you don't have to worry about that. So that's number one. And then number two is the truth is if you took a little grapefruit juice, it would not be the end of the world. And in fact, for rosuvastatin, it probably doesn't matter at all because the way these drugs the way uh certain statins and other drugs interact with grapefruit juice and mandarin oranges, by the way, is through a pathway in the liver called the P450 cytochrome, with a specific enzyme called the 3A4 cytochrome. And that sounds fancy and nerdy, but what it is, is the part of the liver that's responsible for metabolizing drugs and helping the body get rid of drugs. So our livers are wonderful things and they metabolize different chemicals, uh both intrinsic chemicals and extrinsic chemicals. And when you take a drug that is reliant on that system in the liver to remove chemicals, it can start to compete with other things. So what happens when you drink a lot of grapefruit juice or mandarin oranges is that that enzyme system is used for the purpose of metabolizing that food, which is the same enzyme system that's used for certain drugs, including certain statins, but actually not so much for Rosuvastatin. Rosuvastatin has actually been developed so that it has less of an interaction with those type of foods. So if you were taking again simvastatin, then that interaction would be far greater, or if you're taking atorvostatin, that interaction would be considered moderate. So with a lot of medicines that we take, certain medicines for blood pressure and other things, there is that interaction between certain foods and the drugs. And the beauty is that it gets very, very complex. But when you come in for research studying, we will do that evaluation. We will look at your list of medications and your food choices and make sure there aren't negative drug-drug, or drug- food interactions. And that doesn't happen all that much in clinical practice because we're just so busy, but it does happen in the research setting. So it's another reason why we like to encourage people to at least get a research evaluation.

Kevin Geddings:

Yeah. No, absolutely. And when you actually do participate in these clinical trials, which I've done, Karen on our team here has done as well, you're going to get some of the most in-depth, you know, sort of people paying attention to your health status and paying attention to the drugs that you are currently taking than you probably have ever experienced because that's all part of the research process, right, Dr. Koren?

Dr. Michael Koren:

Absolutely. Yeah, there's a lot of details that go into it that may not be that apparent to the average person, but people who have actually participated in research understand that we look at everything extremely carefully, and people love that nurturing, they love that extra attention, they love that attention to detail. So that's what we have to offer patients when they get involved in a research program.

Kevin Geddings:

Right. I guess going back a little bit, like back in the day when it was determined with the older statins that you maybe shouldn't mix grapefruit juice or whatever, would that result have come from research or would that have been because you just knew the chemistry involved?

Dr. Michael Koren:

It's both, actually. So it's it's a great point. So it does start with chemistry, but we actually do something called pharmacokinetic studies. And in a pharmacokinetic study, we're actually looking at interactions between different drugs or different foods and how it affects the way our bodies break down certain chemicals. So early on in the days of Statins, we did these studies called pharmacokinetic studies, and we determined that the concentration of the drug in people who are drinking more grapefruit juice or consuming more mandarin oranges was higher than those that didn't have that exposure. So this is actually the type of clinical trial that we do on occasion. So all the clinical trials have a different endpoint, they have a different focus. And in fact, we've done plenty of studies. As we speak, we're doing studies that are looking at pharmacokinetics or how things interact with each other.

Kevin Geddings:

There's a really good website, medevidence.com, where you can learn more about that and so many other topics, right, Dr. Koren?

Dr. Michael Koren:

You bet. Uh we uh we're just getting tremendous, wonderful feedback from MedEvidence. Thank you, everybody who's been listening and watching, and uh more to come. People are enjoying it as uh just a very real, very pragmatic way of learning about medical issues, and we also like to have fun, and that doesn't hurt.

Kevin Geddings:

Yeah. Dr. Koren, thank you for calling in. We appreciate you, and we'll talk with you in a couple of days, okay?

Dr. Michael Koren:

My pleasure.

Announcer:

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