Cholesterol is so important to life that practically every human cell makes it. Cells use the compound to keep their membranes porous and springy, and to produce hormones and other vital substances. The body can make all the cholesterol it needs, but Americans tend to have a surplus, thanks in large part to too little exercise and too much meat, cheese and grease. Fifty years ago, researchers began to suspect that all this excess cholesterol was bad for arteries. But the idea remained difficult to prove — until statins came along.
Once the powerful cholesterol-busting drugs appeared, in the 1980s, scientists were able to show that a drop in cholesterol could keep a person who had suffered one heart attack or stroke from having a second. Later studies pointed to protection for even relatively healthy people. Researchers writing in the American Journal of Cardiology in 2010 declared that the drugs were such cardiovascular heroes they could essentially neutralize the health risks from a Quarter Pounder with cheese plus a milkshake.
So it may come as a surprise that there are scientists still reluctant to join Team Statin. To them, studies showing benefit for people who haven’t had a heart attack aren’t as clean or overwhelmingly convincing as patients and many doctors probably believe.
“Statins are arguably the most widely studied medicines ever,” says IHPI member Jeremy Sussman, a primary care provider at the University of Michigan and the Department of Veterans Affairs in Ann Arbor. “They are also among the most widely used. This makes any controversy an important one.”
The guiding principle Sussman tells his patients is that the lower your risk of disease in the first place, the less you have to gain from statins. Patients also have to factor in their own sense of how much they fear a heart attack or stroke — all the while knowing there are other means of prevention with almost no risk that can get lost in the statin debate, including weight loss, exercise and a better diet. That theoretical 60-year-old man with a 9 percent risk could drop his risk to about 5 percent with 20 minutes of moderate activity each day and better eating habits.