article:Inside Medicine: Chances are, cholesterol pill is of

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(suggest we all email this doc and tell our stories and invite him to this web site!!!)
Inside Medicine: Chances are, cholesterol pill is of little help
By Dr. Michael Wilkes -
Published 12:00 am PDT Saturday, March 31, 2007
Story appeared in SCENE section, Page K1

*http://www.sacbee.com/296/story/146331.html


Heart disease is a major killer in the United States. Let's say I could give you a pill to prevent a heart attack. You would need to take the pill every day for five years at a cost of $3,000. Would you take it? Most would.

But now, let's say that the pill actually prevented a heart attack in one of every 67 people who took the pill for five years. That is, 66 people would take the pill and get no benefit -- only one would benefit, and we can't predict which person that would be. Would you take the pill? This time, you need to think carefully and weigh the pros and cons.

Well, this is exactly the type of information you need to know when choosing any treatment, but particularly when thinking about taking a medicine to reduce cholesterol.

Jenny is a healthy 50-year-old with no history of heart disease in her family. But when she went to her doctor for a checkup, he did the exam and took some blood for cholesterol, which came back elevated. In a follow-up phone conversation, the doctor recommended to Jenny that she start taking a drug to lower her cholesterol. There was no discussion of the expected benefit from the drug (which is probably much less than 1 in 67 over five years).

In the United States, 36 million Americans take a pill each day to lower their cholesterol. For those with a history of heart attack or symptoms of heart disease, the benefits of lowering cholesterol are substantial and well documented.

However, it is not good science to assume that if something helps people after heart attacks, it might also help people who have not had a heart attack. Antibiotics are life-saving for those with pneumonia, but we don't give antibiotics to healthy people as a precaution.

Most of the 36 million people who take cholesterol pills do not have heart disease. Their doctors prescribe pills as a form of preventive medicine -- hoping that lower cholesterol might prevent heart disease in the future.

In some cases, there is no data to support these assumptions at all. In other cases, the data suggest only a very small benefit. Given the small benefit, some reasonable people might decide to not take the pills when they consider the expense and the daily reminder that their bodies are abnormal.

For example, despite official recommendations that women and people over age 65 who have high cholesterol take medication to lower cholesterol, there are no good studies to show a benefit. Admittedly, there might be a benefit -- it's just that we don't know for sure and the data we do have aren't convincing. Yet are patients ever told about this uncertainty?

Jenny was not, and she would have chosen not to take the drug if she understood a bit more about the benefits.

As a recent article in the journal the Lancet points out, if people understood the small magnitude of benefit from taking cholesterol medicine, some might choose a more healthy alternative -- using diet and exercise instead of taking a daily pill. This personal choice might lead to far fewer people taking medications to lower cholesterol.

My point is twofold. First, given the lack of scientific data proving a sizable benefit in otherwise healthy, low-risk people, we might be pushing cholesterol reduction a bit too hard. And second, people should be told, in simple language, the expected benefits of taking a drug so they can decide for themselves whether to take a pill for the rest of their lives.

About the writer:
Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at *drwilkes@sacbee.com.