HEALTH MATTERS: The benefits of statins should be weighed against the risksQ. Although I’ve never had a heart attack, I was recently found to have a 40 to 50 percent blockage of one of my heart arteries. My cholesterol numbers were very good, and I was not put on a statin. But recent research says that there are benefits to statins that go beyond lowering cholesterol. Should I be put on a statin?
By: Dr. Joshua Wynne , Grand Forks Herald
Q. Although I’ve never had a heart attack, I was recently found to have a 40 to 50 percent blockage of one of my heart arteries. My cholesterol numbers were very good, and I was not put on a statin. But recent research says that there are benefits to statins that go beyond lowering cholesterol. Should I be put on a statin?
A. Let’s begin by clarifying what statins are. They are a class of medicine that blocks one of the key steps in the body’s manufacture of cholesterol. They typically have the term “statin” as part of their technical name (like atorvastatin or simvastatin), while their corresponding brand name ends in “or” (like Lipitor or Zocor).
They all can dramatically lower cholesterol. Statins have other effects that seem to stabilize the blockages in the heart arteries and reduce their chance of growing to totally block the artery and thus cause heart attacks, especially in patients who have evidence of ongoing inflammation in their bodies.
However, three related issues come into play as to whether you should be on a statin. First, they are most effective in someone who already has had a coronary event like a heart attack. Although it makes intuitive sense to use statins to prevent a heart problem, their efficacy is less when used for prevention.
Second, although the non-cholesterol lowering blockage stabilizing effects are real when used in prevention, the magnitude of benefit is relatively small. It turns out that most people in your situation would experience no benefit from treatment; only a small minority would avoid a heart attack or other vascular complication.
Finally, the benefits of treatment have to be weighed against the risks. And we know that statins can have serious side effects. So while I would consider the use of a statin if you were my patient, I would want to make sure that you understood the relatively small benefit that you’d accrue, and also the risks of treatment compared with the risk of non-treatment.
Q. I am not sure that I have full confidence in my doctor’s recommendations. Should I get a second opinion?
A. A second opinion is particularly helpful in two situations. The first is the one you describe — when you’re not fully comfortable with what has been recommended. When I sense this in one of my patients (and this doesn’t happen too often), I usually suggest getting an opinion from another physician.
I’m never offended when a patient requests a second opinion. The major downside of a second opinion in this setting is when the other consultant offers different advice. What do you do then? Get a third opinion? You need to think about what you’d do if you get conflicting opinions.
The second good reason for a second opinion is when you have a condition or need a procedure that is uncommon. Going to a larger center that has a lot of experience with a rare condition can be quite beneficial. But remember that even in these situations, having your care coordinated through your local primary care provider remains paramount if you want to have the best care possible.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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