How to Decide Whether You Should Take a Statin

Should you take a statin? It depends on whether you already have heart disease, how high your cholesterol is and whether you have other medical problems that put you at risk.

Many people already know their total cholesterol. But to make a decision about statins, it’s also necessary to measure the levels of the two major types of cholesterol, LDL and HDL. (LDL is the artery-clogging variety that causes heart trouble; HDL helps prevent it.)

The only widely accepted guidelines for statins’ use were issued by the National Cholesterol Education Program six years ago, and much has been learned about the medicines since then. A committee will soon begin the yearlong job of revising the guidelines.

“One critical issue is, should the criteria for treating people be broadened?” says Dr. Richard Pasternak of Massachusetts General Hospital, a committee member. “The answer is yes, but specifically how broad is still a question.”

For now, the guidelines recommend using statins only if eating changes alone fail to bring down cholesterol levels. They figure in whether people have other risk factors for heart trouble. These include smoking, diabetes, high blood pressure, a family history of heart disease at an early age, an HDL level below 35, or older age--defined as over 45 for men and 55 for women.

Guidelines differ for those who already have heart disease and those who do not. For those with bad hearts, they recommend statins if someone has two other risk factors and LDL over 130. With one risk factor or none at all, statins should be prescribed when LDL is over 160.

For those without heart disease, the threshold is higher. Statins are recommended for those with LDL over 160 and two other risk factors, or LDL over 190.