Statins imperfect but best available

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?

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.

Most North Americans can reduce their risk of heart disease 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!