To Your Good Health

Keith Roach, M.D., syndicated columnist

DEAR DR. ROACH: My husband’s doctor is repeatedly pushing statins on my husband. His cholesterol was high in the past and is still slightly high (239 mg/dL — borderline high). I’ve checked the heart risk calculator. It said his risk is 22.1% and goes down to 16.6% if he goes on statins, which is still considered high risk.

Also, my mother had heart surgery for a “widowmaker” (with 90% blockage), and she has been on statins for ages, so I’m thoroughly confused. Also, he has stage 3b chronic kidney disease, and I read that statins could cause problems with his kidneys.

Could you explain the benefit, if any, for him to be on statins? Also, my husband is adamant about not changing his diet. Thanks. I’m really at a loss and am not sure what is best for him.

ANSWER: If there were a medicine that was 100% effective at preventing heart disease and had no side effects, we would recommend it for everyone. Sadly, that doesn’t exist.

The best we have right now is a class of medicines (statins) that reduce relative risk by about 25% and has side effects bad enough to make a person stop it, in about 1% to 5% of people. Because it is not perfectly effective and does have the possibility of serious side effects, we recommend treatment only in people with a high enough risk that the potential harms make treatment worthwhile.

Every person with known heart blockages, like your mother, is recommended for lifelong statin therapy if they can tolerate it and don’t have a good reason not to. People at a high risk, like your husband (22% is considered quite high), are also recommended treatment.

The calculator estimates 5.5% of people like your husband who are treated will not have a heart attack or die from heart disease if they take a statin, when they otherwise would have.

For most people, that’s a good enough result to take the medicine, while other people prefer to take the risk. It is ultimately his decision to make.

Most North Americans can reduce their risk of heart disease quite a bit by improving diet, exercising more, reducing stress, quitting smoking and managing stress better. Often, when people make those changes, they don’t need statins anymore! Also, these lifestyle changes don’t have the risk of medication side effects. But, even if your husband doesn’t make any changes, just taking a statin daily will help.

If your husband likes sports, you might ask him which opposing hitter he would like his team to face: the one who bats .221 or the one who bats .166 — only the downside is that it isn’t a baseball game, it’s whether he gets a heart attack.

Finally, the existing data show statins are generally safe in people with kidney disease, although some need to have the dose adjusted if kidney function is worse than your husband’s.

However, it’s very important to note that, overall, the risk of death is substantially decreased by taking a statin among people with kidney disease, because people with kidney disease are at a higher risk for heart disease and stroke, with which statins help.

EDITOR’S NOTE: Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.8 Virginia Dr., Orlando, FL 32803.


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