Statin Drugs May Help Millions Battle Heart Disease

B O S T O N, May 16, 2001 -- Under guidelines issued Tuesday by the National Institutes of Health, the number of people who can benefit from taking cholesterol-lowering statin drugs nearly triples.

This is only the second time the National Institutes of Health has revised its guidelines for preventing heart disease. Several studies have found that reducing the level of low-density lipoprotein or LDL can reduce the short-term risk of heart disease by as much as 40 percent. Heart disease kills some 500,000 people a year.

For some time, ABCNEWS' Dr. Tim Johnson has been singing the praises of statins. They're extremely effective and have almost no side effects, he says. The new findings appear to confirm this assessment.

Under the old guidelines, 13 million Americans were targets for cholesterol-lowering drugs; under the new guidelines, that number rises to 36 million, meaning far more people should be able to use them to decrease their risk for heart disease.

"We've suspected for a long time that lowering cholesterol would save lives. It's common sense," Johnson said. "But we still had to see the evidence, and we have it now."

Reign in Cholesterol

Based on the 200-page NIH report, which also stressed the importance of diet and exercise in battling cholesterol, Johnson offered the following tips for lowering your risk of heart disease:

Get a complete cholesterol blood profile test every five years, starting at age 20. It should include a total number, LDL (low density lipoprotein), HDL (high density lipoprotein) and triglycerides.

Keep "bad" cholesterol, the LDL kind, below 100.

Keep good cholesterol above 40, slightly above the old guideline of 35.

The targets for cholesterol are much lower than they were, Johnson said. The new goal is to get your LDL, or "bad" cholesterol level, below 100. The old recommendation was 130. Johnson pointed out that these are the strictest guidelines, set for people with many risk factors.

If you don't have any risk factors, you can get away with a little higher bad cholesterol. One of the independent risk factors listed in the report is diabetes, Johnson said on ABCNEWS' Good Morning America.

"Another thing that came out in the report, that I think is important, is that for the first time they have said that diabetes is as important a risk factor as having heart disease itself," said Johnson. "In other words, we know that if you've had heart disease diagnosed, you're at great risk for a heart attack death. They're saying diabetes is just as important."

You're also at higher risk for heart disease if you smoke, have high blood pressure, are older, or if you have a family history of heart disease.

Warning for Women

Another key finding in the guidelines is that women shouldn't rely on estrogen for heart protection, Johnson says.

Many older women have been told that hormone replacement therapy will protect them from getting heart disease. But many questions have been raised about the safety of that treatment, and doctors have also learned that the therapy doesn't really do what it's supposed to do.

"And this report says women should not rely on estrogen for heart protection. They should take statins, these cholesterol-lowering drugs, instead," Johnson said.

The report also has stricter eating guidelines, with more stringent limits on the amount of saturated fat you should eat. It recommends that you get no more than 35 percent of calories from fat and only 7 percent from saturated fat.

Take Cholesterol Drugs Sooner

Finally, the most important point in all of this: Use drugs sooner, rather than later. Tens of millions of Americans would benefit from taking statins, Johnson says.

"Up until now, if you had high cholesterol, we would say, 'Let's see if diet and exercise can help,'" Johnson says. "And only if that didn't work would we put you on medication. But we're saying now: start with the drugs right away."

There are six drugs approved: Mevacor, Pravachol, Zocor, Lescol, Lipitor and Baycol. Yet a seventh drug, Crestor, could be approved this year. *Baycol was removed from the market by drug maker Bayer since this article was first published. Click here to read about the drug's rare side effect.

"The drug companies run a lot of ads telling you one is better than another, but they're more or less the same in effectiveness," Johnson says. "The important thing is that you take one of them."

The drugs are remarkably safe, he notes, but doctors have found that a very small number of patients will have temporary liver problems. So, doctors monitor their liver with simple blood tests, switching to another medication if there's a problem.

If there is a problem, patients should switch to another medication. In the worst case, treatment can be stopped and the liver returns to normal, Johnson says. Even more rare than that is people developing muscle problems from the drug.

Even if you think you're in good shape, go to your primary care physician, get a complete cholesterol profile blood screen and talk to your doctor about assessing your personal risk factors to see if you're a candidate for treatment, Johnson says.