Inside Medicine: Good chance that statins aren't for you

Mr. Scott recently turned 60 and is focused on maintaining his good health. He is about 15 pounds overweight and leads a sedentary life – his only exercise comes from walking to and from the parking lot at his office.

Nonetheless, Mr. Scott is healthy and takes no medicines other than a pill called a "statin" to reduce his cholesterol. Both of Mr. Scott's parents are alive and very healthy. He has no family history of heart disease, and he does not smoke.

Mr. Scott visits his doctor twice a year because of his concern about high cholesterol. Recently, as the doctor entered the exam room Mr. Scott pulled from his shirt pocket a meticulously maintained chart documenting his cholesterol levels over the past seven years. The colorful Excel chart clearly documented that his cholesterol has fallen – about 10 percent – over the past few years. He rightly attributes this drop to the consumption of the statin cholesterol pill.

The reason for this visit is to request a newly advertised pill he assumes will be even stronger than the pill he takes (the new pill Vytorin sells for $100 per month, compared with his current pill, Zocor, which is $30). Incidentally, the new drug was just shown to be no more effective than the cheaper statin drug he uses.

Despite the fact that his cholesterol level is above normal, no one has been honest with Mr. Scott by telling him about cholesterol. Cholesterol is a fat found in the blood and comes from two sources – the diet and production by the liver. Cholesterol itself is not a health risk, in fact our bodies depend on it; for example, it is vital for building hormones and proper brain function.

People do not die of high cholesterol. They die of heart disease. So, our goal is not to reduce cholesterol, it is to prevent heart attacks – a fact we sometimes forget.

In some high-risk people (such as those who have already had a heart attack) blood-cholesterol levels have become a marker for cardiac risk. Logic would suggest that if a person has high cholesterol and it is lowered, the risk of heart attack is diminished.

But this is not universally true. Lowering cholesterol seems to benefit only those who already have heart disease – not people like Mr. Scott, who only have high cholesterol.

Many studies have shown that statins, in otherwise healthy people with only high cholesterol, don't save lives. However, if pharmaceutical companies marketed statins only those people with existing heart disease, sales would be a small fraction of what they could be if they marketed to everyone with high cholesterol (but no heart disease).

In fact, there is now an entire $20 billion industry in cholesterol measurement and control.

So, why are we all consumed with lowering cholesterol?

Perhaps doctors have not critically looked at the studies showing benefit only to a small portion of people. Also, many of the guidelines doctors depend upon have been written by experts who are on the payroll of pharmaceutical companies. (Five of 14 experts including the chairman of the committee that wrote the major cholesterol guideline have these conflicts of interest).

Further, according to John Abramson, a professor at Harvard Medical School, the guidelines suggest reducing saturated fats but they don't mention specifically reducing eggs, meat or dairy products.

Perhaps this is because several of the committee's experts have links with organizations such as the American Egg Board and the National Cattlemen's Association.

The bottom line is that Mr. Scott should spend more time exercising and watching his diet, and he needs to have an informed discussion with his doctor about his need to take a statin.

This is yet another warning bell to doctors that they need to keep well informed and not rely on pharmaceutical promotions to learn about prescribing drugs.

In turn, people are encouraged to do some careful research ahead of time so they know what questions to ask their doctor.

About the writer:

• Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at drwilkes@sacbee.com.