A reader wonders if statins are needed to lower cholesterol

DEAR DR. ROACH: I’m a 69-year-old woman. I recently had a blood test done and my doctor decided to put me on Lipitor based on the results of my LDL test. After reading about the side effects, I am hesitant to take the drug. My LDL level is 128 mg/dL, HDL is 49 mg/dL, and total cholesterol is 192 mg/dL. Over the years my numbers go up and down. I feel that if I had better control of my diet, I could lower my LDL levels without medication. Is this possible? — Anon.
ANSWER: Because all medications can cause harm, it is always a good idea to take a hard look at the risks and benefits of a medication, especially one like Lipitor, which is intended to prevent future problems (heart attack or stroke) rather than treat existing symptoms.
The critical endpoint is not cholesterol levels; this is your risk of “cardiovascular events,” which in this case means death, heart attack or stroke. Cholesterol and blood pressure are among the most important risk factors, but your diet, exercise, family history, smoking, and even nontraditional risk factors (such as stress, sleep, and close relationships with family and friends) also influence your risk of heart disease.
Improving your diet is always a good idea, regardless of your cholesterol levels, because healthy eating has independent positive effects on the heart and many other conditions, as does regular exercise.
When considering starting a drug like atorvastatin (Lipitor), I start with your baseline risk for cardiovascular events. I use the American Heart Association’s PREVENT calculator (tinyurl.com/preventcalc), which uses the most recent data to determine your 10-year risk based on your risk factors.
Assuming you have normal blood pressure, kidney function and BMI, the model predicts that you have an 8.8% chance of having a cardiovascular event in 10 years. Those are pretty good odds: There’s a better than 91% chance that your heart will be fine when you turn 79. Your cholesterol levels aren’t bad, and most of your risk comes simply from the fact that you’re 69 years old. major risk factor for cardiovascular disease.
When treated with a drug like Lipitor, your risk will drop to about 7%, or a 93% chance that everything will be fine. You have to ask yourself, “Is this worth it?” Many readers will say no, and some will say yes. You are at a level where there is no right answer for everyone, so I like to give the person as much information as possible to help them make a decision.
You also need to consider the possible harm from taking Lipitor or another statin. You’ve probably read that some people notice muscle pain, and it’s true. However, in studies in which people did not know whether they were taking a statin, people were just as likely to say they had muscle pain while taking an inactive placebo pill.
However, in clinical practice, when people expect muscle pain, up to 15% of people notice it. Many of these symptoms are caused by expectations rather than a side effect of the medication. Fortunately, true muscle damage from statins is rare, occurring in fewer than 1 in 10,000 people taking the drug in a year.
The vast majority of people who start taking a statin to reduce their risk of heart disease tolerate the medication very well. If your doctor treats an average of 50 people like you, these medications will prevent one cardiovascular event. It could be you.
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Dr. Roach regrets that he cannot respond to individual letters, but will include them in the column whenever possible. Readers may submit questions by email at [email protected] or by mail at 628 Virginia Dr., Orlando, FL 32803.
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