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    letters | controversy over cholesterol advice

    Given risks of statins, guidelines need to be on target

    The new guidelines for use of statins could result in millions more users (“Panel recommends far wider use of cholesterol drugs,” Page A1, Nov. 13). However, thanks to Dr. Paul Ridker, a cardiologist at Brigham and Women’s Hospital, and Nancy Cook, a biostatistician at Brigham, the public has learned that the risk calculator for cardiovascular disease suggested by the American Heart Association and American College of Cardiology overestimates risk (“Heart doctors at odds on risk formula,” Page A1, Nov. 19). This would result in millions being wrongly considered to meet the new guideline for statin use.

    However, even if the calculator were correct, bear in mind that statins can have serious side effects. For healthy people to be taking these drugs, the benefits should clearly outweigh the risks. For example, some healthy people who go on statins will be trading the unfortunate side effect of loss of the use of muscles in the calves for a possible decrease in their future risk of cardiovascular disease, a decrease that might be obtained by risk-free means, such as exercise or eating healthier foods.

    The statin story has a familiar ring to it. A little more than a decade ago, many physicians recommended female hormone supplements to all their postmenopausal patients to reduce the risk of heart disease, even though these drugs increased the risk of breast cancer. A large randomized trial established that the risks of female hormone supplements outweighed the benefits, but by then many women on supplements had unnecessarily developed breast cancer. There were safe alternatives for reducing risk of heart disease in healthy women.

    Lynn Rosenberg


    The writer is a professor of epidemiology at Boston University School of Public Health and associate director of the Slone Epidemiology Center at Boston University.