Steven M. Goldberg M.D., FACC FACP
Since the late 1980’s, a revolution has begun in our understanding and treatment of cardiovascular disease, especially in regards to lipid treatment. In 1985, the Nobel Prize in Medicine was given to Dr. Brown and Dr. Goldstein, who helped discover the enzymes that lead to the development of the statin type of cholesterol pills. These medicines, which hit the market in 1987, were the first truly successful and tolerable medicines to treat cholesterol, especially the bad “LDL” cholesterol, which caused hardening of the arteries (atherosclerosis). With this new class of drugs, it quickly became evident that for every 1% we lowered cholesterol we were able to decrease the risk of cardiovascular events by 2%. Therefore, this class of medication has dramatically reduced the risk of cardiovascular events, heart attacks, strokes, and peripheral vascular disease, a disease where the risks were rapidly rising in America and westernized countries.
This is particularly true for people with diabetes prior heart attacks, strokes and hypertension. Aggressive cholesterol control in these populations has been clearly beneficial in reducing risks. Although good diabetic control is essential to good health, lowering cholesterol seems to be just as important in preventing heart attacks and strokes. There has also been a reduced need for coronary bypass surgery and cardiac stenting due to better preventative care and cholesterol treatments.
The statins (Mevacor (lovastatin), Pravachol (pravastatin), Zocor (simvastatin), Lipitor (alatorvastatin), Crestor (rosuvastatin) and Livalo (pitavastatin) are very safe and well tolerated. Approximately 4-5% of people may develop muscle aches that improve with a lower dose or stopping the medication. Only one or two in a thousand develop minor liver abnormalities that always improve with cutting back or stopping medicine. So these medicines are very safe, very well tolerated and overwhelmingly helpful in reducing the risk of coronary artery disease. So when your physician tells you it is time to start of cholesterol lowering medication, please take his advice very seriously. By taking your medication, seeing you physician on a routine basis for routine blood tests, exercising routinely, and eating a healthy diet, your risks for cardiac disease will be dramatically reduced.