Statins May Help Even After You Quit

Have you been wondering about whether you should begin to take medication to lower your cholesterol levels?  Of course we know that lowering your LDL cholesterol level reduces risk of heart disease. But when do you need to start medicine? How long do you need to take it? If you already have coronary heart disease or have multiple risk factors such as diabetes, you almost surely need to be taking medicine now. This usually means one of the statin drugs.

Preventing a disease is called primary prevention. Preventing further damage from a disease, in this case heart disease, is called secondary prevention. There is no doubt about the effectiveness of statin drugs for secondary prevention.

It's not so clear when people who have no symptoms or signs of heart disease should start taking a statin, or for how long. In a recent issue of the New England Journal of Medicine, we got a peek at the answer.

The researchers report long-term results of their study on primary prevention of heart disease by lowering LDL cholesterol with a statin.

The researchers previously had shown that people with very high LDL cholesterol levels (an average of 192) who took the statin called pravastatin lowered heart attack and death risk. The study covered a five-year period. Now they report that even if people stopped the statin, they still had a lower risk of heart attack during the next 10 years.

The findings are not actual proof. But they suggest that people with very high LDL cholesterol levels can benefit from taking a statin for several years. This also may be true for those with moderately high LDL and other health concerns that increase their risk of heart disease. And perhaps you don't need to take the statin forever once you start it.

The findings also suggest that people at high risk should consider beginning statin therapy at a younger age.

What should you do?

I think most doctors will advise their patients to keep taking a statin or other LDL-cholesterol lowering drug if you need it for primary prevention of heart disease. We need a lot more information before we should change practice.

But if you are age 75 or older and have been taking a statin for primary prevention, talk with your doctor about this study. Ask whether decreasing the dose or perhaps stopping the statin would be reasonable for you. If you take a statin and you already have coronary heart disease, don't stop the statin no matter how old you are.

What are your thoughts on this good news about statin medications? Do you plan to talk to your doctor about it?

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

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