Q:
What type of patient is a good candidate for cholesterol-lowering statin medications?
A:
Anybody who has established cardiovascular disease is placed on a statin. It’s shown to reduce cardiovascular events regardless of the entry LDL cholesterol level. We target the therapy based on how high-risk that individual is.
For people who are free of cardiovascular disease, the initiation of therapy depends on where the LDL cholesterol level is in relation to their overall cardiovascular profile. For the people who are at lowest risk, we intervene at higher levels of LDL cholesterol. For people who are at the highest risk, we intervene when the LDL cholesterol is lower. You match the intensity of therapy not based on cholesterol alone—not in a void—but in the context of the other risk factors.
Q:
Do you find that many patients don’t take their statin medication?
A:
I don’t think adherence to statins is any different than for any other medication that treats an asymptomatic condition, such as blood pressure. In preventive therapy people need to understand how important it is to take their medications regularly.
We deal with this all the time. For example, if someone who has heart failure doesn’t take his water pill, he’s going to feel short of breath—there’s going to be a very clear signal. But when we treat a condition like high cholesterol, there’s less compliance because it’s asymptomatic.
Q:
Are patients able to stop statin therapy easily once they start?
A:
If you stop the medication, your cholesterol will return to baseline after a very short period of time, about four to six weeks. The whole point is that you get placed on a statin if your risk and LDL cholesterol is high enough. And we have to think about the lifetime risk of cardiovascular disease. The fact is, cardiovascular disease is the leading cause of death in industrialized societies. People with persistently high LDL cholesterol should expect to go on a statin for a lifetime—unless it’s somebody who ate a poor diet and didn’t have the motivation, and now they do have the motivation to change their diet and lose weight. If there’s a change in therapeutic lifestyle, you can always reevaluate.
Q:
How has the availability of generic medications changed statin therapy?
A:
The models that evaluated the use of statins in people with high cholesterol were based on a time when the statins were not generic. Since we have cheaper medications now, we should be using statins more frequently, not less frequently, because the burden of heart disease is so high in industrialized societies.
Cholesterol:Your Cholesterol Number
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