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Got statin? Soon, most of us will

| Saturday, Nov. 16, 2013, 12:01 a.m.

We love prescription drugs in America.How deep is the love? Consider this: New heart disease prevention guidelines announced this week could double – yes, double — the number of people who take statins, a class of drugs that lower cholesterol.

By some estimates, roughly 33 million people soon could be popping statins. Oh yeah, I predict some very happy drug companies.

The new guidelines by the American Heart Association and the American College of Cardiology became big news not just because heart disease is our No. 1 killer, but because they suddenly quash the cholesterol reading we've grown to know and hate.

Remember when doctors warned to keep an eye on the LDL cholesterol, the bad boy of the two types of the artery-clogging wax? The associations representing cardiologists and other health experts now say that heart attacks and strokes are not about cholesterol anymore. Instead, they want doctors to use a whole new set of criteria to decide who benefits more from statins, which block the liver's production of cholesterol. Could the death of health fairs where we get free cholesterol and blood pressure readings be on the horizon?

The overhaul is anything but simple. Doctors (at least those who follow the guidelines) will use four specific risk factors to decide if people need to be treated with medication. This includes whether a person has heart disease, diabetes, an LDL cholesterol level higher than 190 and whether your 10-year risk of a heart attack is greater than 7.5 percent. If it sounds complicated, it's because it is.

“I don't think this is something a patient can do on their own,” Dr. Indu Poornima, director of Allegheny General Hospital's Women's Heart Center, told me.

The good news is the guidelines emphasize treating the sickest people, rather than those with just a high cholesterol reading. The bad news is that when it's all said and done, one-third of American adults could be taking statins. That would be 44 percent of men and 22 percent of women.

It all sounds like a big conspiracy by drug companies to make money until you realize this could only mean one thing: A lot of people out there are teetering on the verge of a heart attack or stroke.

All you need to confirm that is to walk through a mall parking lot, where you'll see plenty of smokers and overweight people – those at highest risk of heart disease. With such obvious evidence, why such heavy dependence on drugs instead of ways to fight obesity and smoking?

As Poornima said: “Just because you take a cholesterol pill, that's not going to prevent a heart attack or stroke.”

Dr. Daniel Rubin of Jefferson Regional Medical Center in Jefferson Hills told me people should focus on exercise, eating right and smoking cessation. He believes statins are effective when reasonably used, but agreed there's been too much emphasis on that pesky cholesterol reading. Some doctors, he said, prescribe too many drugs just to get the number at low levels.

“Lower is better but where did people get specific numbers from? It's very nebulous,” he said.

Because the guidelines are such a marked departure from what we're used to, Rubin suggested the medical community will need time to sort them out. True.

In the meantime, it's wise for people to know their risk of heart disease. And it's even smarter to be ever mindful that it can kill us.

Luis Fábregas is a staff writer for Trib Total Media. He can be reached at 412-320-7998 or lfabregas@tribweb.com.

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