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Should Healthy People Take Statins?

FAQ: Preventing First-Time Heart Disease With Cholesterol-Lowering Drugs
By
WebMD Health News
Reviewed by Laura J. Martin, MD

April 2, 2010 – Should healthy people take a cholesterol-lowering drug to prevent heart disease even if they don't have high cholesterol?

The answer, for some people, is yes. It's a controversial answer that raises a lot of questions. Here are WebMD's answers to those questions.

Who should consider taking statins to prevent heart disease?

Statins are a class of drugs that lower cholesterol. In February 2010, the FDA approved the use of AstraZeneca's statin drug Crestor for preventing first-time heart disease. The approval is for people who meet all of the following conditions:

  • Age: Men 50 or older or women 60 or older
  • High blood levels of C-reactive protein (CRP). CRP is an indicator of inflammation in the body. Inflammation is a major part of the process leading to heart disease.
  • At least one other risk factor for heart disease, such as high blood pressure, low HDL "good" cholesterol, smoking, or a family history of premature heart disease

Not included on this list is a high level of LDL "bad" cholesterol. Why? LDL cholesterol is a major contributor to heart disease. But half of all heart attacks and strokes happen in apparently healthy people with LDL cholesterol levels below the current level of concern.

Can a statin drug help such patients? One controversial idea was to test a statin -- AstraZeneca's Crestor -- in people with normal cholesterol levels but high levels of CRP. The AstraZeneca-sponsored JUPITER clinical trial enrolled 17,802 such men over age 50 and women over age 60.

An independent review panel stopped the trial after two years when it became apparent that patients receiving a placebo were having more heart attacks, strokes, angina (heart pain), and death from cardiovascular disease than those taking 20 milligrams of Crestor daily.

Even so, the risk wasn't extreme. There were 251 heart disease events in the 8,901 placebo patients and 142 events in those taking Crestor. But the reduction in heart disease risk was about twice as great as seen in most clinical trials of statins that enrolled patients with high LDL cholesterol.

So who should consider taking Crestor or perhaps another statin to prevent heart disease? The answer: men 50 or older and women 60 or older with relatively low cholesterol but with other factors that put them at high risk of heart disease should discuss statin therapy with their doctors, especially if they have high CRP levels.

The results of this discussion will vary. Different people have different constellations of heart disease risk -- and different reasons they should or should not take statin drugs.

Whether to start taking statin drugs is not a simple decision. Once a person starts statin therapy, treatment may continue for life. And while generic drugs cost less, treatment isn't cheap. Crestor, which is not available as a generic drug, costs about $3.45 per day.

Is This Normal? Get the Facts Fast!

Is Your Cholesterol Level Heart Healthy?
What is your LDL (low-density lipoprotein) level?

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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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