Many of you have probably heard about the new cholesterol guidelines – and some have heard about the controversy that’s accompanied them. There are doctors and cardiologists on both sides of the fence. Great experts, well-versed, with the right attitude.
The recommendations come from a blue-ribbon committee formed by the American College of Cardiology and the American Heart Association. Because cholesterol-lowering drugs are by far one of the most important inventions of the last century, they asked questions.
Which ones work? Which one’s don’t? What number should we shoot for? Who should be on these drugs?
Statins work; other medications don’t. Full disclosure: I have prescribed and researched some of the drugs that this august committee says are worthless.
Zetia and Vytorin, which generate $4 billion a year in sales, push down the bad cholesterol numbers but don’t reduce heart attacks. Niacin – Abbott Laboratories’ drug Niaspan has $1 billion in sales – also should be tossed in the trash.
The committee said that nonstatins have no proof of efficacy. Are there exceptions to this blanket rule? Ah, in medicine there are always exceptions. But on the whole, for most of us, the statement holds true.
Now, what about those cholesterol numbers – what should your goal be? Before this, we assumed that for most healthy people, the LDL (bad cholesterol) number should be less than 130. For those with diabetes, it should be less than 100, and for those with a previous heart attack, less than 70.
The committee said we’ve been slaves to the numbers. They basically said the numbers don’t count as much as we thought they did, but being on a statin in any dose is what counts.
Statin side effects are real. For lots of those taking statins, it’s achy muscles. For others, it’s muscle wasting. For women, it increases the risk of diabetes. For all of us – and I include myself, as I take a statin – it might be memory loss. And for the rare bird, it’s liver damage.
I think the bottom line here is that statins count. Lower doses may be just as effective as higher doses, but other earlier studies and many cardiologists still think higher doses are better.
I continue to believe that for those at very high risk, the lower the bad cholesterol the better off you are. But the science behind that gets weaker every year.
If you’re on statins, don’t stop them or reduce them. But do sit down with your doctor and decide together. Controversy is the bread and butter of science. This play has just begun.
Finally, the loyal opposition has said that this committee has gone overboard in recommending more people be on statins. For example, they came out with a complicated calculator that’s supposed to measure the 10-year chances you’ll have a heart attack. If it’s greater than 7.5 percent, you should take a statin.
Well, what if you’re a healthy person who eats right and exercises and have a 7.6 percent 10-year risk? It’s just over the threshold. Should you really take these drugs for the rest of your life? Hmmm .
This should give you food for thought and lots to talk about at your next medical visit.
Dr. Zorba Paster is a physician, university professor, author and broadcast journalist. He also hosts a radio program at 3 p.m. Saturdays on WBFO-FM 88.7; email questions to him at firstname.lastname@example.org.