Why So Many Cardiologists Start This Low-Cost Medication Before Heart Trouble Appears

IN HIS MID-30S, cardiologist and Men’s Health advisor Christopher Kelly, MD, noticed that a surprising number of his cardiology colleagues were taking statins even though their cholesterol levels were not extremely high. Dr. Kelly was generally healthy himself. His cholesterol was not ideal, but only moderately elevated. Still, he had a family history of heart disease and understood the evidence showing that these cholesterol-lowering drugs can reduce the risk of heart attack and stroke.

So he started taking one as well.

Ten years later, he is still on a statin. For a physician who relies on evidence-based medicine, it was a somewhat unconventional choice: “There's really not a lot of research in young, healthy people with moderately elevated cholesterol taking a statin and what the long-term effects of that are,” he says. Even so, there is some support. The large Hope 3 clinical trial found benefits for people with cardiovascular risk, even when that risk was not tied to high cholesterol.

Dr. Kelly says he sees his decision as a more aggressive approach to lowering risk, especially during a demanding stretch in his career when his habits were merely average. “I wish I could say that my lifestyle was ideal, but it was difficult as a cardiology fellow to find the time for regular exercise or cooking healthy foods,” he says. MH has previously reported on the quick heart-healthy habits cardiologists use when time is short, and statins are another example for Dr. Kelly and many of his peers.

C. Noel Bairey Merz, MD, director of the Preventative & Rehabilitative Cardiac Center at Cedars-Sinai, says this sort of calculation is common among physicians. “If I give a lecture about some aspect of ischemic heart disease, and the audience is 100 percent cardiologists, and I say, ‘How many of you are taking a statin?’ almost every hand goes up,” she says. Part of that reflects the audience, which is often made up of men in their 50s who may be more likely to have elevated cholesterol than younger people. But she says it also shows doctors’ confidence in the benefits of these medications.

Statins are considered safe, have few side effects, and are backed by more than 30 years of strong scientific evidence. “These are miracle pills, and they're less than a penny a day,” says Dr. Bairey Merz. In other words, if protecting your heart matters, why not consider what the experts are quietly doing?

Why Start a Statin Before You ‘Need’ One?

CARDIOLOGISTS ARE NOW discussing a concept called “LDL years.” Adedapo Iluyomade, MD, a cardiologist at Miami Cardiac & Vascular Institute, Baptist Health South Florida, explains that this refers to the number of years your arteries are exposed to high LDL cholesterol. The longer that exposure lasts, the greater the risk of heart disease, stroke, or heart attack.

Statins are best known for lowering LDL, the “bad” cholesterol that gradually builds up in arteries and raises the risk of cardiovascular problems. Dr. Iluyomade compares the process to gardening: removing weeds early and consistently helps prevent overgrowth from choking healthy plants, just as early treatment may help protect the heart.

“That concept has been shown and proven in studies,” he says, adding that he has seen the same pattern in practice. One study found that statin therapy lowered the risk of atherosclerotic cardiovascular disease, caused by plaque buildup in artery walls, by about 26 percent, even when LDL levels were not extremely high.

(How young is too young to take a statin? Cardiologists recently told MH a surprising answer.)

Doctors Look at the Full Health Picture

THE DECISION TO take a statin should not be based on cholesterol numbers alone. It is really about whether lowering those numbers will reduce the chance of a cardiovascular event, and not everyone faces the same level of risk.

“Cholesterol years” may be useful to think about, but they are not the whole story. Someone with mildly elevated cholesterol over time who also smokes, carries extra weight, feels stressed, and has a family history of heart disease or diabetes faces a very different outlook from someone with similar cholesterol levels but no family history, normal blood sugar, and healthy habits, Dr. Iluyomade says.

“We oftentimes focus too much on the number, and the use of statins should really not be about reducing the cholesterol number, but about reducing someone's risk,” he says. That means taking a broader view that includes age, blood pressure, smoking, family history, stress, genetics, and other factors rather than focusing only on cholesterol correction.

Although statins are generally very safe, they can still cause side effects, including muscle aches, small increases in liver enzymes, or a higher diabetes risk in people already predisposed. The risk of rhabdomyolysis, in which muscle tissue breaks down, is extremely rare. Knowing overall cardiovascular risk, not just cholesterol levels, is what matters most.

Can a Doctor Prescribe a Statin Without High Cholesterol?

Current guidance for statin use generally works like this:

• If LDL levels are very high (≥190 mg/dL), statins are recommended. For LDL, ideal levels are under 100 mg/dL. “High” begins at 160 mg/dL, and “very high” at 190.
• If you are a man between 40 and 75 and have at least one risk factor, such as hypertension, diabetes, or smoking, and your chance of a heart attack or stroke in the next decade is above 10 percent, you should consider a statin, according to The U.S. Preventive Services Task Force. A doctor may use a tool such as PREVENT to estimate that risk.
• If your 10-year risk is lower, in the 7.5 to 10 percent range, and you have a risk factor, the group says a statin may still help, but the benefit is smaller than it is for people at higher risk.

Dr. Kelly says doctors often follow USPSTF guidance, so patients may need to bring up statins themselves. He says he is comfortable prescribing one to patients whose LDL is below 190 mg/dL if they are willing to take it daily and want to lower their risk, but he cannot make a strong case for it based on the evidence alone, despite his own personal choice. He notes that there is still no high-quality research showing large benefits for otherwise healthy people.

Even so, if you want to explore statin therapy, it is worth discussing with your doctor. These medications are relatively inexpensive and very safe, and without insurance they can cost only a few dollars a month.

As with any medication, the choice is personal. Whatever your situation, lifestyle remains the foundation of every treatment plan. Dr. Iluyomade says, “These medications will not work their best if you're not doing your part.”