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If Bush Needs a Cholesterol Drug, Do You?

Are Cholesterol-Lowering Statin Drugs Even Good for Healthy People?

WebMD Health News

Dec. 14, 2004 -- If the county's top doctors say President Bush, an avid exerciser they describe as being in "excellent" health, needs a cholesterol-lowering statin drug, do you, too?

Although the team of specialists at the National Naval Center in Bethesda, Md., declared President George W. Bush "fit for duty" after his annual physical exam on Saturday, they still recommended that he take a daily aspirin and a statin to help prevent heart disease.

Statins are the most widely prescribed cholesterol-lowering drugs and include Crestor, Lescol, Lipitor, Mevacor, Zocor, and Pravachol. High cholesterol levels increase the risk of heart attack, death, and other heart disease-related problems.

But Bush's doctors said he had a "low" to "very low" risk of heart disease, and his total cholesterol level was listed as 170 mg/dL, which is considered within the normal range.

So why would he need a statin? According to the most recent guidelines for cholesterol treatment, a healthy diet and exercise should be adequate for a healthy 58-year-old with no major risk factors for heart disease, such as high blood pressure or diabetes.

Experts tell WebMD that the President's cholesterol treatment plan may seem a bit aggressive, but it may be part of a growing trend in statin use.

"I can't fault Bush's management," says Paul D. Thompson, MD, director of preventive cardiology at Hartford Hospital in Hartford, Conn. "It looks like the trend is to treat people more aggressively."

Antonio Gotto Jr., MD, dean of the Weill Medical College of Cornell University in New York City, calls Bush's treatment plan optimal rather than aggressive.

"It's estimated that there are 46 million people who could benefit from statin treatment in the United States, and there are only about 12 million taking them," says Gotto. "The problem is not overuse, it's underuse. So I applaud President Bush's doctors for being astute enough to realize the potential benefits to him from taking statins as a preventive measure."

Risks vs. Benefits of Statins

Several studies have indicated that increased use of statins could significantly reduce the risk of heart attack, death, and possibly stroke in those at high risk for the disease.

Less is known about how beneficial these cholesterol-lowering drugs are in people at low risk for heart disease, such as President Bush.

But a study conducted by Gotto showed that people with normal total cholesterol but low HDL "good" cholesterol levels (below 40) had a 37% reduction in heart attack risk over five years by taking a statin.

However, cholesterol specialist Frank Sacks, MD, professor of medicine and nutrition at the Harvard School of Public Health in Boston, says the chances for benefit for any particular person at low risk for heart disease are minimal.

"Let's say a person's 10-year risk of heart attack is 5%, the statins would reduce that risk to just under 4%. So a person would have a maybe one in 100 chance of having a benefit from taking that statin," says Sacks. "A lot of people would say forget it. Some people would say, 'Well what do I have to lose?'"

Is This Normal? Get the Facts Fast!

Is Your Cholesterol Level Heart Healthy?
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Answer:
Desirable
0-199
Borderline
200-239
High
240+

Your level is currently

Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is optimal.

Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is near optimal.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is borderline high. If your LDL goes higher, your total cholesterol level could become Borderline High. Consider reducing the amount of foods you eat with saturated fats and increasing physical activity. If you get more exercise, your level of "good" HDL cholesterol may increase, which could also help to keep your levels of LDL and total cholesterol in check.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL. The HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is Very High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL because the HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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