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Cholesterol lowering medications: do they help you if you’re healthy?

Pharmaceutical companies successfully advertise and sell cholesterol lowering medications.  Healthcare providers do what they’re trained to do – prescribe drugs.  And consumers are caught in the middle.

A new study has reignited the controversy about the value of statins, a popular cholesterol lowering medication, in people without known heart disease.

People with known cardiovascular disease benefit from these medications.  But only a quarter of people taking statins, take it for this reason.

The majority of people take statins for primary prevention – that is, they’re free of cardiovascular disease and are taking the medication to prevent a first event. And the evidence is weak that these medications work for primary prevention, suggesting we may be prescribing a medication that for most people, does more harm than good.

The new study, published last month in the Archives of Internal Medicine, was a meta-analysis of 11 studies that asked the question – do statins prevent heart disease when used for primary prevention?   The people in this study were at high risk for heart disease – for example, they had diabetes or high blood pressure.

This study was the cleanest, most complete look at the use of statins for primary prevention in a high-risk population.  Other studies that looked at this question included a mix of patients with and without heart disease, potentially biasing the results.

This analysis of over 65,000 people demonstrated that statins had no impact on all cause mortality or death.

But this isn’t the first time that the use of statins for primary prevention has been questioned.  For years, many researchers have questioned whether or not we need to drive down the cholesterol, particularly the LDL cholesterol, in people without known heart disease.

For example, you may remember the TV ad for Lipitor a few years ago that starred Dr. Robert Jarvik, the inventor of the artificial heart.  That ad proclaimed that “Lipitor reduces the risk of a heart attack by 36 percent…in patients with multiple risk factors for heart disease.”

But that ad overstated the benefits. In the study where the 36 percent benefit was reported, 3 percent of people taking a placebo or sugar pill had a heart attack compared to 2 percent of people taking Lipitor.  So, for every 100 people in the study, which lasted over three years, there was one less heart attack in the Lipitor group.  In other words, you needed to treat 100 people at high risk for heart disease with Lipitor for more than three years, in order to prevent one person from having a heart attack.  Meanwhile, the other 99 people had no benefit from taking Lipitor.

The meta-analysis did have a major limitation – the studies reviewed followed people for short periods of time, typically 5 to 7 years.  And those who promote statins for primary prevention believe that you need to take them for a longer period of time before you see the benefit.

So what about the about the value of statins for primary prevention in people who are at low risk for heart disease.  Well, here we know even less.  Yet millions of people who are at low risk for heart disease are taking these medications every day.

If you are taking a statin or other cholesterol lowering medication, what should you do?

Go in and talk to your provider.  Ask if you really need to be on that medication.  Although cholesterol lowering medications can benefit patients with know heart disease, the benefits for others is less clear.

Also, focus on other ways to improve your heart health.  Don’t smoke.  Maintain a normal body weight.  Exercise, eat a well balanced diet, and find healthy ways to reduce or deal with your stress.

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