DR. MOHLER: If you have a healthy heart & elevated cholesterol, should you take a ‘statin’?
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
Your doctor just called to tell that your cholesterol came back high and she wants to start you on a drug, a statin, to lower your cholesterol. Although you are quite healthy, she feels that taking this new drug will lower your risk of a heart attack. You have heard that statins cause muscle problems. What should you do?
Fortunately, there is a large clinical study and a tool called “Number Needed to Treat” (NNT) to answer your question. The study showed that when healthy patients with a high cholesterol were treated with a statin for 3.3 years, 2% had a heart attack, while in the sugar pill group 3% had a heart attack.
So, how do you figure out NNT and what does it mean? If the math gives you a headache, skip to the next paragraph.
NNT = 1/difference in rates between two groups
NNT = 1/3%-2%=1%
NNT = 1/0.01 = 100
A NNT of 100 means if you treat 100 patients with a statin for 3.3 years, you will prevent one heart attack. Over 3.3 years, one patient out of a 100 will benefit from the medicine and avoid a heart attack, but 99 out of 100 will pay for the drug, reap absolutely no benefit, and yet be exposed to the side effects of the medicine.
How many patients taking a statin develop muscle symptoms? About 1 in 10, or 10%, will experience muscle pain. So using the same idea, the “Number Needed to Harm” (NNH) for taking a statin would be 10.
There is no right or wrong answer about healthy persons with high cholesterols taking a statin. This is a situation where shared decision making with your physician is important. If you prize avoiding a heart attack at all costs, a statin may be your best choice. On the other hand, if 1 out of a 100 chance of helping and a one out of 10 chance of aching muscles seem like bad odds, you may want to avoid a statin.
Dr. Mohler has practiced family medicine in Grand Junction for 38 years. He has a particular interest in pharmaceutical education. Phil works part-time for both Primary Care Partners and Rocky Mountain Health Plans.
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