Should I take Cholesterol Pills?

A lot of people wonder “Is my cholesterol too high?  Do I need to take a cholesterol medication prevent a heart attack?”  The answers are not that simple but the chance that taking a cholesterol pill (Statin) will help you is  low even if you’ve had a heart attack.  Plus, taking Statins is not without risk.

If you have a heart attack, the studies (which are arguably biased) show that taking a Statin will help prevent a second heart attack (secondary prevention) in a small percentage of people.  If you compared two groups of people and one group took a Statin and the other took a sugar pill for 5 years, the first group would have about 3-4% fewer heart attacks and maybe 2% fewer deaths.   In other words, about 96% of people treated with a Statin would not benefit from taking it.  But 4% would benefit.  As a doctor, I will have to treat 83 patients every day for 5 years with a Statin to prevent one death.

Other interventions are much better like committing to a Mediterranean diet, exercising, enjoying your work, or stopping cigarettes.

If you’ve never had a heart attack, the benefit of Statin drugs is not settled, but if they do prevent heart attacks, the percent of people who would benefit is very small. has brief and insightful summaries of the evidence.

This graph from the Framingham study is interesting.  According to Framingham, a Cholesterol of 210 was the most prevalent reading for those who never had a Heart Attack and 225 was the most prevalent reading for those who did.  There is obviously some correlation between elevated Cholesterol and increased risk of heart attack.   But correlation does not mean causation.  High cholesterol does not cause heart attacks.  If it did, the graphs would look much different.

The 2013 Cholesterol Guidelines are an improvement in several important areas.  I will comment on those guidelines in another post.

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