Experts debate preventive use of statins

No question, the cholesterol-fighting statin drugs have been a powerhouse class for Big Pharma. One of them--Pfizer's ($PFE) Lipitor--was the best-selling branded medication of all time, and plenty of others have delivered blockbuster revenues to their makers. That's because, for years now, the conventional wisdom has put statins in a simple equation: High "bad" cholesterol + statin therapy = less heart disease.

But now, some experts are questioning whether statins should really be prescribed to patients who have high LDL, but are otherwise healthy. The Wall Street Journal takes a look at this debate in its "Big Issues" feature. Here's a summary.

Pro: Johns Hopkins' Dr. Roger S. Blumenthal says there's "a mountain of high-quality scientific evidence" proving that statin therapy does lower heart risks in people with high levels of LDL. He cites studies showing that "cardiovascular events" such as death, heart attack and stroke can be reduced by up to 40% with statin use. To Blumenthal's mind, treating risk factors for heart disease--such as high cholesterol--is the only responsible approach. Otherwise, the first sign of cardiovascular problems could be an actual heart attack. Most of the claims about side effects are anecdotal, he says, and advising against the drugs on that basis is "risky and unethical."

Con: University of California at San Francisco professor Dr. Rita Redberg says people who already have heart disease are indeed helped tremendously by statin meds. But "for most healthy people," data show that statins don't prevent heart disease, extend life or improve quality of life, she writes, and they come with "considerable side effects." To justify using statins to prevent heart disease, doctors need long-term clinical trials, despite the expense, she contends. She questions commonly cited studies said to show that healthy people benefit from statin use; one, for instance, focused on men at high risk--most were smokers and obese--rather than the average person with high cholesterol. And she cites "recent studies" that document side effects such as diabetes risk and muscle problems.

- read the WSJ piece