How to calculate your risk
A set of guidelines issued by the National Heart, Lung and Blood Institute (NHLBI) helps doctors decide when to prescribe statins, which provide much of their benefit by lowering LDL, the so-called "bad" cholesterol, Hlatky says.
They factor in LDL levels, signs of coronary disease and risk factors such as smoking, diabetes, high blood pressure and too little HDL, the "good" cholesterol. They also use a risk calculator — based on the findings of the huge, multigenerational Framingham Heart Study — to calculate a patient's likelihood of dying from heart disease within the next 10 years.
Statins should be considered for patients with elevated LDL, two or more risk factors and a heightened 10-year risk of dying, the guidelines say.
Reasons to take statins
Many practitioners, however, say the NHLBI guidelines don't go far enough, in light of recent studies suggesting that an even wider range of people might benefit from taking statins.
A landmark clinical study dubbed JUPITER ("Justification for the Use of Statins in Primary Prevention"), followed 17,802 men and women with normal cholesterol but with high levels of C-reactive protein, a sign of inflammation associated with greater risk for heart disease. (That protein is measured in a blood test.)
The trial was halted early because those taking placebos seemed to be at a higher risk for death. Lead author Paul Ridker, Harvard Medical School professor and director of the Center for Cardiovascular Disease Prevention at Brigham and Women's Hospital, says the men and women taking statins saw 45 percent fewer heart attacks and strokes than those on placebos, along with a 20 percent reduction in deaths.
But the study has some vociferous critics, who believe statins are overprescribed and think that the risks and expense of taking the drugs outweigh any possible benefit in primary prevention.
Statins don't cut the risk of dying nearly as much as heart-healthy habits do, contends John Abramson, M.D., a lecturer with the Department of Health Care Policy at Harvard Medical School.
"The healthy lifestyle includes regular exercise, a Mediterranean-style diet, not smoking and drinking in moderation," he says. "People who do that seem to have about a 60 percent lower death rate than people who don't." The United States lags behind other countries in heart health measures despite our high rate of statin use, Abramson observes. "The bottom line is, most of your health is in your own hands," he says. "Don't let other people convince you that they can fix it with other products."