Are Statins Right for You?

And so things now stand. In the absence of new clinical trials, the researchers who reported in the British Medical Journal used complex mathematical analyses of four previous studies to conclude that statins can reduce the risk of suffering a heart attack even in men and women with normal cholesterol levels and no signs of heart disease. Since this population is fairly healthy, however, doctors might need to treat 250 or more people to save a single life. A bargain for the one whose life is spared, but not so great for the majority, who would not only bear the expense but would also be exposed to potential side effects from a treatment that might turn out to have been unnecessary.

So for the time being, doctors consider the following individuals to be potential candidates for treatment with statins: those whose LDL is 190 mg/dl or higher; those whose LDL is 160 mg/dl or higher and who have at least two risk factors for heart disease, such as smoking, diabetes or high blood pressure; and those whose LDL is 130 mg/dl or higher and who suffer from heart disease.

Many questions remain unanswered. Researchers have shown, for example, that taking an aspirin a day can reduce a heart patient's risk of suffering a heart attack. Would combining aspirin with a statin have a synergistic effect, or is one better than the other in preventing heart disease? Similarly, many cardiologists are impressed by the ability of another group of drugs, called ACE inhibitors, to normalize high blood pressure and reduce the strain on the heart. Would they work better alone or in combination with other drugs?

Dr. Sidney Smith, director of the center for cardiovascular disease at the University of North Carolina in Chapel Hill, predicts that doctors will be much more aggressive in their use of such preventive strategies in the next year or two. "Statins are one therapy; ACE inhibitors are another," he says. "There are pretty powerful data that medical therapy can arrest the progression of coronary disease and atherosclerosis and cut down on cardiac events." As always, the art of medicine is in taking that information and figuring out who will benefit most.