Should You Be Taking a Statin?
By Linda Marsa
Photo by emagineart/Flickr
Tristan Marquez is trim and physically active and, at age 55, has no signs of heart disease. But last fall, when her total cholesterol measured 260 and the so-called bad LDL cholesterol hit 173, her physician wanted to immediately start her on a cholesterol-lowering statin.
Marquez, a Los Angeles real estate agent, decided to first try to bring the numbers down without pills. She now loads up with fruits and vegetables, scrutinizes package labels to steer clear of saturated fats and salt, and hits the gym at least three times a week. “I live like a monk,” says Marquez. “If my doctor tells me to take a statin, I will. But I’d prefer to correct this without drugs.”
Like Marquez, millions of Americans who don’t have heart disease – and who might not even have elevated cholesterol – may be startled to be handed a prescription at their next checkup. Last November, the American Heart Association and the American College of Cardiology issued sweeping new guidelines for staving off heart disease, which, as the nation’s number one killer, will claim 600,000 lives this year. The new rules, in a revolutionary change aimed at improving prevention, significantly lowered the threshold at which someone’s risk profile is considered worrisome enough to merit medication, while doing away with specific cholesterol target numbers and hitting hard on lifestyle changes instead.
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The shift could more than double the number of statin takers to 56 million, according to a Duke University study. The potent statins now making up the therapeutic arsenal – including Zocor, Lipitor, Crestor and Pravachol – work by reducing the amount of cholesterol produced by the liver. They can shrink LDL cholesterol by up to 60 percent, boost levels of the “good” artery-clearing HDL cholesterol, prevent the buildup of perilous fatty plaques, and reduce triglycerides, blood clotting and inflammation, all of which contribute to heart disease.
Under the previous guidelines, healthy people were advised to keep total cholesterol under 200 milligrams per deciliter and their LDL to a max of 160; 130 to 159 was borderline. Anyone with heart disease was encouraged to bring the LDL number down to less than 100; whittling it down to 70 was even better. People at some risk, who are obese or who have high blood pressure, for example, were told to aim for 130 or less. Based on a complicated formula that factored in five key risks (age, smoking history, blood pressure, HDL level and family history), people whose predicted likelihood of a heart attack over the next 10 years was 20 percent or greater were advised to consider drugs.
The updated recommendations expand the risk factors to include race, using a new online estimator to spit out a person’s 10-year and lifetime chances of being hit by heart attack and dying from cardiovascular disease, and, for the first time, of suffering a stroke. And they set the bar for a serious talk about statins at just 7.5 percent. Since up to 80 percent of cardiovascular disease is caused by unhealthy lifestyle habits such as smoking, carrying around extra pounds, eating fat-laden foods (story, Page 72) and being a couch potato, everybody is advised to stick to a healthy diet and get 40 minutes of exercise three or four times a week, cut back on salt, reduce sugar intake and keep saturated fat to 5 or 6 percent of calories.