Today's subject, let's call him Patient B, is a 72-year-old Caucasian male presenting no symptoms (non-smoker, no medications, not diabetic, no history of cardiovascular problems, elevated but "well-controlled-for-his-age" blood pressure, doing moderate daily exercise). He's trying to decide whether to take daily statins to lower his cholesterol count, which breaks down to: total 231 (standard range 100-199); "bad" LDL 149 (standard 0-99); "good" HDL 63 (over 39 — the higher the better). Statins, which inhibit the body from synthesizing cholesterol, would reduce his LDL and total cholesterol levels to acceptable levels at a cost of just $4 per month for a daily dose.
Statins appear to have little downside. Some people do experience harmful side effects, such as muscle pain and — less commonly — liver damage and digestive problems, but most of these potential users can be weeded out in advance; e.g. if you're a heavy drinker, don't take them.
Our subject notes that the recommendations from the American College of Cardiology and the American Heart Association (AHA) for statin therapy have recently changed to be far more inclusive than previously. Whereas the old guidelines recommended daily statins for 43 million Americans between the ages of 40 and 75 on the basis of LDL numbers, the current recommendations put 56 million of us (nearly half of the 40-to-75 age group) in the statins category, using a "risk formula." If the formula says you have at least a 7.5 percent risk of having a heart attack or stroke over the next 10 years, you're advised to take statins. (Previous recommendations remain unchanged for diabetics, anyone who has already had a cardiovascular event, and people with LDL over 190.)
When our subject enters his information into the AHA online calculator, he discovers he has a 24 percent risk of having a heart attack or stroke over the next 10 years (i.e. on average, for every 100 people, 24 will have such events). He notes that optimal numbers (170 total cholesterol and 50 LDL cholesterol, 110 systolic blood pressure) would halve his risk. Hoping to get closer to optimal values, he elects to take a generic statin (lovastatin 20 mg) for a year, then re-test.Still, he worries. There’s something inherently weird about taking a daily pill to reduce his 10-year risk by a measly 1.2 percent per year. He accepts that he, and millions like him, are probably not total dupes of Big Pharma (like Pfizer, which sold $12.4 billon worth of atorvastatin in 2008), that the controversial new recommendations weren’t made lightly (one of their authors notes that the group examined 60,000 papers over a five-year period before publishing) and that this is a real issue. Over half of us will suffer a cardiac event, and a third of us will die of cardiovascular disease. And yet ...
His problem is that he doesn’t have a problem so far. And if he’d used another calculation method, his odds would instantly improve! The Framingham Risk Score calculator, for instance, gives him a 10 percent chance of coronary heart disease in the next 10 years. (This doesn’t factor in stroke risk, as the AHA calculator does.)
By way of rather obvious disclaimer, Patient B is an engineer, not a doctor, so (duh) talk to your physician before doing anything, and take the above with a grain of salt — but no more; too much salt is bad for your blood pressure.
Barry Evans (email@example.com) also worries that his Field Notes anthologies are getting lonely at Northtown Books, Eureka Books and Booklegger.