I don't want to be on a drug': Confusion over new cholesterol guidelines


Athlete and gym rat Nick Ragone doesn’t seem like the type of guy whose cholesterol is out of whack. He even likes vegetables. 

But a few months ago, routine blood work showed a total cholesterol reading of 288, far above the gold-standard reading of 200 or below. Plus, his so-called “good” cholesterol or HDL, and “bad” cholesterol, or LDL, readings were also less than optimal. Now, Ragone, 42, is eating lots of fish and whole grains, and upping his cardio workout — all in hopes of staying off medication.

But he wonders if new guidelines issued by the American College of Cardiology and the American Heart Association this week outlining the groups of individuals who will most benefit from heart attack and stroke reduction from cholesterol-lowering statin medications means that a prescription for one of the drugs is in his future. 

“I don’t want to be on a drug since I’d rather see if I can get my cholesterol in line with diet and exercise,” says Ragone of Bethesda, Md. “But if I’m really at risk for a heart attack and stroke and a drug helps protect me, I guess I will be amenable.”

Ragone may not be alone. Many more people — maybe up to one-third of the U.S. adult population — may soon be having a conversation with their doctors about their risk for heart attack and stroke and how a cholesterol-lowering statin, such as Lipitor, Mevacor, Crestor or Zocorm, can protect them. 

The new guidelines call for doctors to place less emphasis on cholesterol levels and more emphasis on an individual’s specific risk for heart attack and stroke. That means doctors should prescribe statins to patients who are at high risk of having a heart attack or stroke in the short-term, such as those who have had a previous heart attack or stroke, people with Type 2 diabetes, and those with very high levels of LDL cholesterol linked to a familial risk.

Among other things, the guidelines also call for doctors to prescribe statins to patients who have a 7.5 percent risk of suffering a stroke or a heart attack over the next 10 years. 

Atorvastatin Calcium tablets, a generic form of Lipitor, which is being sold under a deal with Pfizer.
Atorvastatin Calcium tablets, a generic form of Lipitor, which is being sold under a deal with Pfizer. Bill Gallery

“What we are trying to do is save lives and improve quality of life, and we can do that by getting the right people on the right statin at the right amount,” says cardiologist Carl Orringer, M.D. of University Hospitals Case Medical Center in Cleveland. “Statins reduce cholesterol but, the emphasis isn’t really on the numbers. Statins reduce a patient’s likelihood of a heart attack and stroke. For patients who are particularly at risk for problems, these guidelines can help protect them from potentially devastating consequences.”

Although his phone has not been ringing off the hook — yet — he does expect that the next few weeks will bring a number of questions from patients and from doctors. “I’m sure there is some confusion among patients as to whether they need a statin, if they need a higher or lower dose, or maybe don’t need one at all,” Orringer says.

Count among the confused patients Ruth Latona of Wyckoff, N.J. The 70-year-old retired business manager has been taking Lipitor for about 10 years. Although her total cholesterol is slightly high, her LDL and HDL levels are good. “I really don’t understand these guidelines when they say they are not going to be looking at numbers anymore,” she says. “I’m a finance person and I like looking at numbers.”

She is planning on talking to her doctor soon about the guidelines and if there is something more that they should be doing to reduce her risk of heart attack and stroke. “I really want to know if we are doing all we can,” she says.

Jim Nichols of Cleveland Heights, Ohio, spent a little bit of time Wednesday morning reading about the new guidelines. Nichols, 51, is an avid athlete, whose cholesterol topped out at about 240. His HDL and LDL levels weren’t good either. He was always opposed to taking medication, so when he was prescribed a statin several years ago, he initially balked at the idea. But the drug has helped, and more importantly, he says, it has reduced his risk for heart attack and stroke.

“A pill is not a substitute for a healthy lifestyle, but I could be a vegan and my cholesterol wouldn’t come down without meds,” he says. “Frankly if my doctor ups my dose, because of these guidelines, I will be just fine with that.”

Doctors agree the guidelines will probably take a little bit of time for patients — and doctors, too — to completely digest. But there’s no need for Nick Ragone, at least at this point, to think his medicine cabinet will be stocked with a statin. “Lifestyle will always be the first line of therapy that we offer anyone,” says cardiologist Martha Gulati, M.D., of The Ohio State University Wexner Medical Center. “And if lifestyle isn’t a part of your treatment already, you need to find a new doctor.”

Although she hasn’t gotten a lot of calls yet, either, she knows people will have questions. “These (guidelines) have presented evidence-based data in a beautiful, elegant way, and have made it very clear to family practice doctors, internists, and cardiologists, how statins improve outcomes,” she says. “It’s really pretty amazing.”