Rosuvastatin

Mechanism of action

• Reduces cholesterol production in the liver
• Upregulates hepatic LDL receptors
• Increases removal of LDL cholesterol from blood
• Lowers LDL-C substantially, and also lowers triglycerides modestly while raising HDL-C slightly

Indications

• Primary hypercholesterolemia / mixed dyslipidemia, to lower LDL cholesterol
• Familial hypercholesterolemia, including heterozygous and homozygous forms
• Hypertriglyceridemia
• Primary dysbetalipoproteinemia (Type III hyperlipoproteinemia)
• Prevention of major cardiovascular events in adults at increased cardiovascular risk, including myocardial infarction, stroke, cardiovascular death, and arterial revascularization procedures. See the current FDA prescribing information.

Adverse effects

• Myalgia or muscle aches
• Headache
• Nausea
• Constipation
• Abdominal discomfort
• Weakness or fatigue

• Myopathy: muscle pain or weakness with raised creatine kinase
• Rhabdomyolysis: rare severe muscle breakdown that can cause acute kidney injury
• Raised liver transaminases and rarely clinically important liver injury
• Small increase in fasting glucose and HbA1c, with possible new-onset diabetes in predisposed people
• Proteinuria or hematuria, usually transient
• Rare immune-mediated necrotizing myopathy
• Rare hypersensitivity reactions such as rash, urticaria, or angioedema

Main priorities

1. Lower triglycerides and prediabetes risk
   • Avoid sugar, sweets, sweetened tea/coffee, fruit juice, soft drinks, honey/jaggery, bakery foods, refined flour, white rice, large potato portions, and frequent snacks.
   • Avoid alcohol completely, especially if triglycerides are elevated.
   • Control total carbohydrate portion size, even for healthy foods.
2. Lower LDL cholesterol
   • Replace ghee, butter, cream, coconut oil, palm oil, cheese, fried snacks, and commercial bakery products with small amounts of olive, mustard, groundnut, rice-bran, or canola oil.
   • Emphasize soluble fiber, beans, oats, nuts, and seeds.
3. Do not try to “raise HDL” with special foods
   • HDL usually improves more with physical activity, weight reduction if needed, stopping smoking, and lowering triglycerides than with a specific food.

Best vegetarian foods to eat regularly

Vegetables

• Leafy greens: spinach, fenugreek leaves, amaranth, mustard greens, lettuce
• Cruciferous vegetables: broccoli, cauliflower, cabbage
• Gourds: bottle gourd, ridge gourd, bitter gourd, zucchini
• Okra, eggplant, beans, capsicum, mushrooms, tomato, cucumber
• Carrot, beetroot, pumpkin: healthy, but keep portions moderate because they are relatively higher in carbohydrate

Fruits

• Guava
• Apple or pear, with skin
• Orange, sweet lime, grapefruit
• Berries, if available
• Kiwi
• Papaya
• Peach, plum, or pomegranate

• Mango
• Grapes
• Chikoo/sapota
• Banana
• Custard apple
• Dates, raisins, dried figs, and other dried fruit

Protein foods

• Dal, chana, rajma, lobia, black beans, chickpeas
• Soybeans, tofu, tempeh, unsweetened soy milk
• Sprouts, preferably lightly cooked if digestion is an issue
• Low-fat unsweetened curd/yogurt, buttermilk without added sugar
• Low-fat paneer in modest portions
• Eggs, if the person is lacto-ovo vegetarian

Whole grains and high-fiber carbohydrates

• Oats or steel-cut oats
• Barley
• Millets such as jowar, bajra, ragi, foxtail millet
• Whole wheat roti
• Quinoa
• Brown rice or hand-pounded rice, in a small portion
• Whole-grain bread, without added sugar

Nuts, seeds, and healthy fats

• 5 to 10 almonds or 2 to 4 walnut halves daily
• 1 tablespoon ground flaxseed daily, mixed into oats, curd, or dal
• 1 tablespoon chia seeds, soaked
• Pumpkin or sunflower seeds in small amounts
• Unsweetened peanut butter, 1 tablespoon if needed

Herbs and spices

• Turmeric
• Cinnamon, as a flavoring
• Garlic
• Ginger
• Fenugreek/methi leaves
• Cumin, coriander, mustard seeds
• Curry leaves
• Mint, basil, coriander leaves
• Lemon and vinegar for flavor instead of excess salt

A simple one-day vegetarian meal plan

• Vegetable oats or besan chilla with vegetables
• Or 2 small vegetable idlis with sambar
• Add unsweetened curd or tofu/paneer as protein
• Tea/coffee without sugar, or with a non-sugar sweetener if needed

• One apple, guava, orange, or a bowl of papaya
• Plus a few almonds or walnuts

• Large salad or cooked non-starchy vegetables
• 1 to 2 small whole-wheat/millet rotis, or 1/2 to 3/4 cup cooked brown rice
• One large bowl dal/chana/rajma/tofu curry
• Plain low-fat curd

• Roasted chana, sprouts chaat, or buttermilk
• Avoid biscuits, namkeen, sweetened drinks, fried snacks, and fruit juice

• Half plate vegetables
• Tofu, paneer, dal, or beans
• 1 small roti or a small serving of millet/quinoa
• Keep dinner earlier and lighter than lunch

Lifestyle measures that matter as much as food

• Aim for at least 150 minutes/week of moderate exercise, such as brisk walking, plus 2 days/week of strength exercises if medically safe.
• A 10 to 15 minute walk after meals can help reduce post-meal glucose.
• If overweight, losing about 5% to 7% of body weight can materially reduce progression from prediabetes to diabetes. The Washington Manual recommends dietary change, weight loss, and at least 150 minutes/week activity for prediabetes.
• Sleep 7 to 9 hours and address snoring or possible sleep apnea.
• Check fasting glucose, HbA1c, fasting lipid profile, blood pressure, kidney function, liver enzymes, and thyroid function as advised.

Important triglyceride safety point

What research suggests

• In people with abnormal cholesterol, some small trials and a meta-analysis of 11 randomized trials suggest sea buckthorn preparations may modestly improve total cholesterol, LDL, triglycerides, and HDL. The benefit was not consistently seen in healthy people. A review of this evidence is summarized in this sea buckthorn clinical review.
• In people with impaired glucose regulation, a small randomized crossover trial of sea-buckthorn fruit puree found only a slight decrease in fasting glucose over 5 weeks. It did not establish that it prevents diabetes or meaningfully lowers HbA1c (trial report).
• Therefore, it can be viewed as an optional food, not a replacement for a statin, diabetes-prevention plan, exercise, weight management, or prescribed treatment.

The major concern: juice can contain sugar

• Choose 100% unsweetened, no-added-sugar sea-buckthorn juice.
• Check the label for carbohydrate and sugar content.
• Use a small serving, such as 30 to 50 mL diluted in water, with or after a meal, rather than a large glass.
• Do not add sugar, honey, or jaggery.
• Do not use it in place of whole fruits, vegetables, oats, pulses, flaxseed, nuts, or prescribed medicines.

Safety

Practical recommendation

• Eliminate sweet drinks and fruit juices
• Daily vegetables, legumes, oats/barley, flax or chia, and a few nuts
• Controlled portions of whole grains and fruit
• Avoid ghee, butter, fried snacks, bakery foods, and refined carbohydrates
• Brisk walking or equivalent activity at least 150 minutes weekly
• Repeat fasting lipids and HbA1c as advised