If Bush Needs a Cholesterol Drug, Do You?
Are Cholesterol-Lowering Statin Drugs Even Good for Healthy People?
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?'"