Should you take a cholesterol-lowering drug? Study questions who is best candidate

Jan 21, 2010 4:43 PM

In the U.S., cholesterol-lowering drugs called statins are the most commonly prescribed type of medication. These drugs can help prevent heart disease, heart attack, and stroke. But there’s disagreement in the medical community over who should be given these medicines. The debate may now heat up, because a new study challenges the conventional guidelines for prescribing these drugs. Here’s what you need to know.

Widely accepted guidelines from the National Cholesterol Education Program, or NCEP, call for using the drugs to reduce cholesterol levels (particularly the "bad" cholesterol or LDL) to a certain target number. But a computer simulation study published this week in the Annals of Internal Medicine found that by using a different approach—one that "tailors" the treatment based on a person’s calculated risk of developing heart disease—would prevent more deaths and disabilities. The calculated risk takes into account not only cholesterol levels, but also age, family history, smoking, high blood pressure, obesity and diabetes.

In the new study, researchers from the University of Michigan Medical School and Yale University School of Medicine used data from more than 4,500 real people between 30 and 75 years old who had never suffered a heart attack to generate a simulated population of 1 million people. Then, they ran different scenarios to see how those people fared on various treatment options. In one, they used the "treat to target" approach. Another scenario looked at giving a drug to a person based on their calculated 5-year risk of developing heart disease. If their heart disease risk was between 5 percent to 15 percent, they were given simvastatin (Zocor and generic), and if their risk was greater than 15 percent, they were given a more potent drug, atorvastatin (Lipitor).

Compared to even the most intense "treat to target" strategy, the tailored approach saved a calculated 520,000 more quality-adjusted life-years, a measurement of the complications and deaths due to heart disease the treatment strategy prevented. In addition, under the tailored approach, fewer people were treated with high-dose statins, which studies have shown can increase the risk of dangerous side effects, such as muscle and liver problems.

Bottom line: Don’t toss out the NCEP guidelines just yet. Our medical advisors recommend that you continue to follow the current guidelines if you need to take a statin for high cholesterol. The simulation study is food for thought about the best way to use statins, but we need evidence from well-conducted clinical trials to show whether the simulation results hold up in the real world.

—Steve Mitchell, associate editor, Best Buy Drugs

To learn more about cholesterol and statins, check out our free Best Buy Drugs report.

Photo: morgueFile