In Lowering Cholesterol, How Low Do You Go? This week's new study showing that a cholesterol-lowering statin drug can cut the risk of heart attack or stroke has opened up a debate over how aggressive doctors and patients should be when it comes to using statins — and who should take them.
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In Lowering Cholesterol, How Low Do You Go?

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In Lowering Cholesterol, How Low Do You Go?

In Lowering Cholesterol, How Low Do You Go?

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This is Morning Edition from NPR News. I'm Renee Montagne.


And I'm Ari Shapiro. Steve Inskeep is on assignment. Today in "Your Health," we return to a study on heart disease that made big news this week. It shows that older people with perfectly good cholesterol levels can sharply reduce their risk of a heart attack or a stroke by taking a drug to get their cholesterol really low. NPR's Richard Knox looks at who needs to be on cholesterol-lowering drugs.

RICHARD KNOX: Annette Convery(ph) of Framingham, Massachusetts, is one of those people who didn't seem in danger of a heart attack, says cardiologist James Alderman.

Dr. JAMES ALDERMAN (Cardiologist): She has an excellent HDL level of 62. LDL level, excellent. This lipid profile is not one that would shout out someone being at risk for a heart attack or an acute coronary syndrome.

KNOX: But last week, Alderman cleared major obstructions from one of Convery's coronary arteries. That pulled her from the brink of a heart attack. This Tuesday, she was back for a checkup with Alderman's colleague, Dr. Elizabeth Asher(ph).

Dr. ELIZABETH ASHER (Cardiologist): Mrs. Convery, how are you? Lovely to see you.

Ms. ANNETTE CONVERY (Clerk, Framingham Police Department): Hello.

KNOX: Convery's in her 70s, but she looks much younger.

Dr. ASHER: Now we've fixed the plumbing. So how are you doing?

Ms. CONVERY: I'm doing fine. I feel quite well and...

KNOX: She works as a clerk in the Framingham Police Department. Her brothers had heart trouble in their 60s, but not her sisters.

Ms. CONVERY: I have a family history, but I never thought it was going to concern me. I have plenty of energy. I thought I was quite healthy.

KNOX: Asher explains the plan to prevent another cardiac emergency. She prescribes a high dose of a cholesterol-lowering drug called a statin.

Ms. CONVERY: Is it possible that if I had been taking a statin, this might not have happened?

Dr. ASHER: It is possible.

Ms. CONVERY: And that's the ultimate goal, isn't it?

Dr. ASHER: It is possible.

KNOX: The study that came out this week increases that possibility. Participants with desirable cholesterol levels, like Convery's, had nearly half the chance of a heart attack, stroke, or cardiovascular death if they took a potent statin for less than two years. Dr. Lori Mosca of Columbia University says for men over 50 and women over 60...

Dr. LORI MOSCA (Director of Preventive Cardiology, Columbia University): This trial really shows us that it's quite reasonable to consider using statin therapy and that getting our cholesterol levels really to levels we've never seen this low before might actually really be beneficial.

KNOX: This adds up to millions and millions of people. So which ones should be on aggressive statin therapy? The new study implies those who have an elevated level of a chemical in their blood called C-reactive protein, or CRP, using a highly sensitive test. That may mean there's inflammation in the arteries that sets the stage for a heart attack or stroke. The study has intensified debate about the CRP test. Some doctors are enthusiastic, but Mosca says she usually doesn't need a CRP to tell who's at risk.

Dr. MOSCA: If you have an increased waist size, you almost always have a high C-reactive protein. It's highly correlated with belly fat. So, you know, measuring someone's waist size doesn't cost anything.

KNOX: And doctors already measure other things that go along with high CRP, such as high blood sugar and high blood pressure. All this talk about unsuspected disease made me want to know my risk of heart disease. I'm in the age bracket the new study covered. So I asked another Framingham heart specialist, Dr. George Kinzfogl, to assess my risk. Most of what we know about cardiovascular risk factors, after all, comes from Framingham. Thousands of residents have participated in the famous 60-year-old Framingham Heart Study.

Dr. GEORGE KINZFOGL (Cardiologist): If we put your numbers into the Framingham risk calculator...

KNOX: Which you have on your cell phone?

Dr. KINZFOGL: Yeah. Your total cholesterol again?

KNOX: 169.

Dr. KINZFOGL: And do you know what your last blood pressure reading was?

KNOX: 124/80.

Dr. KINZFOGL: Do you smoke?

KNOX: No, I never have.

Dr. KINZFOGL: So based on the Framingham risk score, it says that your risk of developing a cardiovascular event in the next 10 years is 12 percent, which puts you into an intermediate risk category.

KNOX: That's a bit of a shock. I always thought I was one of those lucky low-risk people. Dr. Kinzfogl says if I were his patient, he'd order a CRP test on me. If it were high, he'd start me on a statin drug. But I think I'll take Dr. Mosca's advice. I'll tackle those extra pounds of abdominal fat. After losing some, I might want to ask my doctor to test my CRP, just out of curiosity. Richard Knox, NPR News, Boston.

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