Healthy? At Low Risk For Heart Disease? Relax About Cholesterol.

Do healthy people with high cholesterol gain anything from taking statins to prevent heart disease? Should you be treating your risk factors instead of your cholesterol?

In the  back rooms of Medicine, doctors have been debating whether statins -- cholesterol and lipid-lowering prescription medications -- are being vastly overused. For several years most general practitioners and internists looked at your cholesterol and lipid levels, and if they were higher than they liked, they'd give you a few months to clean up your diet, recheck those levels, and then prescribe a statin like Lipitor, one of the biggest selling drugs of all time.

Now, a growing number of physicians are  questioning this approach. Earlier this month a study came out showing that women on statins are at significant risk of getting type 2 diabetes, which is a considerable risk factor for heart disease. And now, as guidelines for physicians about how to manage cholesterol are in the works (from the National Cholesterol Education Program Adult Treatment Panel), a public debate has surfaced. Basically, many are arguing that physicians should be focusing on your overall risk factors for heart disease first. If they're high, then consider taking a statin. If they're not, don't. 

If your risk of heart disease is low, some physicians say statins won't help you much. In fact, side effects and potential drug interactions could actually hurt you.  In an opinion piece published online January 17, 2012 in Circulation: Cardiovascular Quality and Outcomes, Harlan Krumholz, MD, of Yale University School of Medicine and Rodney Haward, MD, of the University of Michigan argue that physicians should stop treating based on LDL-cholesterol targets and instead focus on a patient's risk of having a heart attack. They say if the risk is low, skip the drugs and avoid side effects and unnecessary costs. 

In the Wall Street Journal today,  Rita Redberg, MD, a professor of medicine and director of woman's cardiovascular services at the University of California, San Francisco, debates Roger Blumenthal, MD, arguing that statins don't help healthy people live longer or feel better. "For most healthy people, the data show that statins do not prevent heart disease...I can't in good conscience recommend them [for healthy people]."

How do you judge your own heart attack risk? You can plug your data into the Framingham Risk Score calculator, and you should talk with your healthcare provider about what cardiac health risks you may have. Factors include your blood pressure, weight, whether you smoke or have diabetes, whether you're male or female, your age, and your cholesterol levels. (One warning: the currently available calculators are based on the old guidelines from the National Cholesterol Education Adult Treatment Panel).

The debate continues. If you're healthy and you want to be sure to do all you can to prevent heart disease, look at what has been proven without a doubt to be effective: Exercise, eat well, don't smoke, watch your blood pressure and maintain a healthy weight. And until the debate about the benefits of anti-cholesterol medications is resolved, keep asking your healthcare provider for the facts as they pertain to you personally.