Cholesterol Drugs: In Wider Use

A major study judging the benefits of cholesterol-lowering drugs in people with normal cholesterol has hit print, generating a new round of speculation about the proper use of these drugs, called statins. First presented at the American Heart Association meeting in November – and reported in our January issue – the study now appears in the May 27 Journal of the American Medical Association.
Researchers recruited 6,600 healthy people age 45 or older with normal cholesterol and randomly assigned half of them to take lovastatin, a common cholesterol-lowering prescription drugs without a prescription. The other half took dummy pills. After five years, fewer people in the drug group than in the placebo group had developed unpredictable chest pain, had a first heart attack, or needed bypass surgery or angioplasty. The researchers concluded that, if 1,000 people with normal cholesterol took lovastatin for five years, the drug would prevent 17 bypasses or angioplasties, 12 heart attacks, and 7 cases of unpredictable chest pain.
Studies like this are leading doctors to prescribe statins for people who once would have been urged only to eat better and exercise. Now you’re more likely to get that advice plus a statin prescription. But cholesterol-lowering drugs aren’t for everyone: They do carry a small risk of side effects, diet and exercise may actually work better in some cases, and nobody wants to sign up for a lifetime of pills unless it’s necessary.
When are statins necessary? Currently, national guidelines call for drug treatment when you have heart disease and an LDL (bad) cholesterol level over 130; when you don’t have heart disease but do have two or more risk factors and your LDL exceeds 160; or when you don’t have heart disease and have no more than one risk factor but your LDL exceeds 190. (Risk factors include high blood pressure, being a man 45 or older or a woman 55 or older, family history, smoking, diabetes, and low HDL cholesterol – the good kind.) But many cardiologists, following the lead of studies like this one, are treating people more aggressively than the guidelines recommend, giving statins to even low-risk patients when their LDL exceeds 130, for example. Our advice: Use diet and exercise to keep your LDL as low as possible. But if your LDL is 130 or above – regardless of your risk profile – talk to your doctor about the possibility of taking a statin. He or she can gauge the best move for your particular situation.
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