Statins ?

[Guest guest]

An interesting article.

 

Inside Medicine: Chances are, cholesterol pill is of little help

Sacbee.com

By Dr. Michael Wilkes -

Published 12:00 am PDT Saturday, March 31, 2007

 

Heart disease is a major killer in the United States. Let's say I

could give you a pill to prevent a heart attack. You would need to

take the pill every day for five years at a cost of $3,000. Would

you

take it? Most would.

 

 

But now, let's say that the pill actually prevented a heart attack

in

one of every 67 people who took the pill for five years. That is, 66

people would take the pill and get no benefit -- only one would

benefit, and we can't predict which person that would be. Would you

take the pill? This time, you need to think carefully and weigh the

pros and cons.

 

 

Well, this is exactly the type of information you need to know when

choosing any treatment, but particularly when thinking about taking

a

medicine to reduce cholesterol.

 

 

Jenny is a healthy 50-year-old with no history of heart disease in

her

family. But when she went to her doctor for a checkup, he did the

exam

and took some blood for cholesterol, which came back elevated. In a

follow-up phone conversation, the doctor recommended to Jenny that

she

start taking a drug to lower her cholesterol. There was no

discussion

of the expected benefit from the drug (which is probably much less

than 1 in 67 over five years).

 

 

In the United States, 36 million Americans take a pill each day to

lower their cholesterol. For those with a history of heart attack or

symptoms of heart disease, the benefits of lowering cholesterol are

substantial and well documented.

 

 

However, it is not good science to assume that if something helps

people after heart attacks, it might also help people who have not

had

a heart attack. Antibiotics are life-saving for those with

pneumonia,

but we don't give antibiotics to healthy people as a precaution.

 

 

Most of the 36 million people who take cholesterol pills do not have

heart disease. Their doctors prescribe pills as a form of preventive

medicine -- hoping that lower cholesterol might prevent heart

disease

in the future.

 

 

In some cases, there is no data to support these assumptions at all.

In other cases, the data suggest only a very small benefit. Given

the

small benefit, some reasonable people might decide to not take the

pills when they consider the expense and the daily reminder that

their

bodies are abnormal.

 

 

For example, despite official recommendations that women and people

over age 65 who have high cholesterol take medication to lower

cholesterol, there are no good studies to show a benefit.

Admittedly,

there might be a benefit -- it's just that we don't know for sure

and

the data we do have aren't convincing. Yet are patients ever told

about this uncertainty?

 

 

Jenny was not, and she would have chosen not to take the drug if she

understood a bit more about the benefits.

 

 

As a recent article in the journal the Lancet points out, if people

understood the small magnitude of benefit from taking cholesterol

medicine, some might choose a more healthy alternative -- using diet

and exercise instead of taking a daily pill. This personal choice

might lead to far fewer people taking medications to lower

cholesterol.

 

 

My point is twofold. First, given the lack of scientific data

proving

a sizable benefit in otherwise healthy, low-risk people, we might be

pushing cholesterol reduction a bit too hard. And second, people

should be told, in simple language, the expected benefits of taking

a

drug so they can decide for themselves whether to take a pill for

the

rest of their lives.

 

 

About the writer:

Michael Wilkes, M.D., is a professor of medicine at the University

of

California, Davis. Identifying characteristics of patients mentioned

in his column are changed to protect their confidentiality. Reach

him

at drwil....