PhotoMillions of people take statins, a class of drugs used to lower cholesterol. Statins have been shown to be effective at blocking a substance in the human body that is needed to produce cholesterol and these drugs are considered a powerful tool against heart disease.

Statins are marketed under a number of brand names, including Lipitor, Zocor and Crestor, and are among the best-selling drugs in America.

Should you be taking one? It all depends.

Doctors at the Mayo Clinic have long advised that the decision to go on a statin will depend on a number of risk factors at particular patient faces.

High cholesterol

High cholesterol is certainly one risk factor. If your total cholesterol level is 240 milligrams per deciliter (mg/dL) or higher, or your low-density lipoprotein cholesterol -- LDL, or "bad" cholesterol -- level is 130 mg/dL (3.37 mmol/L) or higher, your doctor may write a statin prescription.

But if high cholesterol is the only risk factor you have, the Mayo Clinic staff says you may not need a statin. And new research gives patients and doctors new advice in making that call.

A report by cardiologists at Johns Hopkins surveys a wide area of research and focuses on the benefits and potential downsides to long-term statin use.

"Given that heart disease tops mortality charts as the number one-killer of Americans, 'to statin or not to statin' is one of the most important questions faced by patients and physicians alike," said lead author Seth Martin, an assistant professor of cardiology at the Johns Hopkins University School of Medicine. "Our report offers concrete tips for clinicians on how to conduct this vital discussion and to reduce patient uncertainty and frustration in making this complicated decision."

Current guidelines

Guidelines from the American Heart Association and the American College of Cardiology advise that in people with high cholesterol but no sign of heart disease, the decision to start preventive statins -- which usually must be taken for the remainder of the patient's life -- should consider, among other things, the patient's real likelihood of suffering a heart attack or stroke over the next decade.

The guidelines say doctors should consider preventive statin therapy for those whose 10-year risk score for suffering a heart attack or stroke is 7.5 percent or higher. But the Johns Hopkins cardiologist say the guidelines leave a lot of room for variation.

So how do you make the decision? The experts say it all hinges on the physician's clear explanation -- and the patient's correct understanding -- of the benefits and risks of statins for the individual patient.

"It's a simple concept: making sure we're not treating the disease but the person with the disease, and, in this case, those at elevated risk for it," Martin said. "Done the right way, this is precision medicine at its best."


Here are some tips offered by the Johns Hopkins cardiologists:

  • Don't get fixated on a number. In recent years, a patient's cardiovascular risk score has emerged as the guiding factor in clinical decision-making about preventive statins.
  • Give patients a voice in the decision but research shows patients want the doctor to take the lead.
  • Make the time to have a comprehensive discussion between doctor and patient to completely go over the pros and cons. It might take longer than the typical office visit.
  • A discussion of the benefits of statins should also include the risks, including what the Hopkins researchers call the 5 Ms of potential side effects: memory, metabolism, muscle, medication interaction and major organ effects.

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