This little drama plays itself out in doctors' offices thousands of times every day. After your annual physical, your blood work comes back from the lab with a cholesterol reading above 160, the high range for the "lousy" cholesterol, LDL (low-density lipoprotein). Even though it seems you're in good health – your blood pressure is in order, and there are no other flag-raising lab results – your internist fixes you with a look of concern and strongly advises you to go on statins to drop that LDL number. If you do, you'll be in good company: One in four men over age 45 takes the medication, the most prescribed class of drugs in America. Statins are a $14-billion-a-year industry, accounting for 215 million prescriptions filled annually.
Or you could just say no.
In the past few years, three major research reviews have arrived at the same conclusion: Statins provide real benefits to those who already have heart disease, but for those whose only risk factor is high LDL, not so much. How is it that one of the most popular prescription drugs for men is potentially ineffective? Statins interfere with the liver's ability to produce cholesterol, and less LDL in the blood means there's less available to accumulate as plaque that clogs up arteries, increasing the risk of heart attack. But for people without evidence of heart disease, their risk of keeling over from a heart attack is already so low that the statins don't seem to buy much extra protection. Dr. David Newman, head of clinical research in emergency medicine at Mount Sinai, has crunched the numbers for 25,000 to 30,000 people with no known heart disease who have been on statins for five years. The drugs saved no lives, but they did help prevent nonfatal heart attacks in 1.6 percent of this group. That's not nothing, but it's got to be weighed against the 10 percent who developed muscle problems caused by side effects from the drugs and the 1.5 percent who developed statin-driven type 2 diabetes.
Odds are this news has not reached your primary care physician – or if it has, it likely didn't cause him to change his prescription-writing habits. "Doctors often think they're dispensing magic, which just reflects their poor understanding of the research data," Newman says. Statins are serious drugs that fight a serious disease, but if you've got high LDL, not cardiovascular disease, they shouldn't be your first line of defense.
So what to do? The boilerplate, but no less true, answer is to change your diet. The Mediterranean diet, rich in fresh vegetables, fruits, olive oil, and fish, is one of the most effective for heart health, shown to reduce heart attacks by 30 percent, according to a landmark study in the New England Journal of Medicine this past February – more than any drug on the market. While reducing heart attacks beats reducing LDL any day, if you or your doctor is worried about those cholesterol numbers, simply substituting those types of foods for carbohydrates and trans fats can drop your LDL cholesterol by 10 percent. If you lose five pounds and add regular exercise to dietary changes, you might get a 15 to 20 percent reduction – on par with the results from taking statins. "If you have a choice, Mother Nature will always trump Mother Pharmaceutical Industry," says preventive cardiologist Dr. Michael Ozner, author of Heart Attack Proof.
You can also take a more targeted dietary approach. A 2011 multicenter study published in the Journal of the American Medical Association found that people who received counseling about eating a handful of specific cholesterol-lowering foods (see next page) dropped their LDL numbers by 10 percent more than a group on a standard heart-healthy diet low in saturated fat. One big caveat here, for the men whose livers are genetically programmed to produce high amounts of cholesterol: "There's a limit to how much diet and exercise can do for them," says Dr. Dennis Goodman, clinical associate professor of medicine at New York University, "and they actually are good candidates for statins."