Q. Since I am taking a statin medication to lower my cholesterol, does this mean I don't need to watch my diet?

A. Statin medications such as Lipitor, Pravachol, Zocor, Crestor and Mevacor are effective weapons in reducing heart attack risk. However, don't assume that taking a statin makes you invulnerable. It won't cancel out a diet of frequent loco mocos and chicken katsu plate lunches. Statins complement dietary changes. They don't replace them.

Statins significantly reduce LDL cholesterol by blocking an enzyme needed to make cholesterol. Excess LDL is harmful because it deposits fat into the artery walls, forming plaques. These plaques reduce the elasticity of the artery and block the flow of blood to the heart.

Statins also reduce inflammation. Inflammation is an immune-system response to injury of blood vessel walls caused by plaques. Inflammation makes the plaques in the artery walls unstable. If the inflamed plaque bursts, it can block blood flow to the heart or brain, triggering a heart attack or stroke.

Inactivity, obesity, smoking and diabetes also promote inflammation. If you are prescribed a statin, addressing these issues by decreasing calories, getting active, controlling blood sugar and quitting smoking can further decrease your chances of suffering a heart attack. Eating fish also helps reduce inflammation.

Several studies have shown that cholesterol-lowering medications combined with lifestyle changes reduce the chance of heart attacks better than just taking medicine alone. These changes include cutting down on fatty meats, deep-fried foods and pastries. At the same time, increase fish, fruits, vegetables, beans, whole grains and soy. Also, try to include 30 to 60 minutes of physical activity most days of the week. In addition to making your medicine work better, these steps may allow you to take a lower dose of your cholesterol-lowering medication.

Heart disease isn't the only illness affected by diet and lifestyle. A heart-healthy lifestyle can decrease the risk for developing diabetes, high blood pressure, strokes and certain types of cancers.

Ideally, the answer to the heart-disease epidemic is not statins; it's prevention. We need to teach our keiki to choose foods that promote good health and to engage in physical activity so that they will not need these medications when they become adults. Statins could then be reserved for those whose risk for heart attack is due to genetics and family history rather than an unhealthy lifestyle.

Amy Tousman is a registered dietitian and certified diabetes educator with Nutrition Unlimited in Kailua. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.