Drug treatment, such as use of statins, works for those with proven heart and vascular disease, or at high risk of developing it when diet and lifestyle changes do not reduce cholesterol levels sufficiently. That is the unequivocal verdict of cardiologist Prof Vincent Maher.
Based on the wealth of scientific evidence, where people have raised low-density lipoprotein LDL (bad) cholesterol in their blood, it causes atherosclerotic heart disease, he underlined – “particularly in the presence of smoking, high blood pressure and diabetes”.
For those without proven heart and vascular disease, genetic cholesterol disorders or at low risk of heart attack or stroke, international expert bodies “recommend lifestyle/dietary intervention and surveillance”.
However, more refined detection of underlying heart and vascular disease “should guide the need for drug therapy in these situations”, he said.
Prof Maher, who is based in Tallaght University Hospital, was responding to a recent study which claimed there was no evidence high levels of total cholesterol, or of "bad" cholesterol, causes heart disease and questioned the benefits of cholesterol-lowering statins when used as primary prevention of cardiovascular disease.
The benefits, he noted, were clear: “reducing LDL cholesterol by 1 millimoles per litre reduces heart disease by 22 per cent over a five- year period – so for those with vascular disease if you reduce your LDL level from 3 to 2, it reduces your heart disease risk by a more than a fifth.”
Prof Maher added: “Like with aspirin, people without a risk of vascular disease from cholesterol do not need drug treatment. However, it is misleading to confuse people regarding this carefully considered approach to addressing cholesterol’s contribution to Ireland’s biggest cause of mortality.”
His key message to people with high LDL was to get it checked out, “regardless of how well they think they are”. Most cases were easy to treat, though others are more complex where a specialist clinic was needed, when for example someone does not “tolerate medication”.
“Drug treatment is indicated for those with proven disease or at high risk of developing disease when diet and lifestyle interventions don’t sufficiently reduce LDL levels,” he explained.
Statins had not been shown to cause memory impairment or other problems, except for occasional muscular problems which were manageable, Prof Maher said. A risk of liver disease was so remote, that surveillance for this possible link was discontinued in the US. He accepted, however, there was a 9 per cent chance of developing diabetes “where the recommendation is to continue statin treatment as the best option to avoid heart disease”.
