The answer is too complex to fully answer in this space. However, in my opinion, there are merits to both sides of this contentious argument, but i try to sit more in the middle. There is good evidence that if you have had a heart attack
or have blocked arteries
, if you treat high cholesterol
levels with a statin, you reduce the risk of additional events or even the risk of death. The question that remains uncertain is how aggressively to lower your cholesterol level, in particular the ldl
, or bad cholesterol
On the other hand, if you have no history of heart disease, but have elevated cholesterol levels, the scientific literature is more scant. The number of "primary prevention" trials is more limited, although many do show benefits to lowering cholesterol levels with statins
. The central question is to determine your risk. There are short-term and long-term risks, and most studies assess short-term risk. Unresolved questions include when do the medications to lower your cholesterol need to be started, specifically what age, and what long-term benefits are there? The studies are difficult to conduct because they would cost too much money, hence they haven't been performed.
Finally, our understanding of cholesterol metabolism and heart disease, while enhanced daily with new scientific information, still remains relatively primitive. There are too many factors we don't understand. Thus, our ability to determine whom to treat is a very crude approach based on your risk factors and cholesterol levels.
Regardless of this discussion, i always try behavioral changes
first, including weight loss, dietary changes, and exercise
to lower cholesterol, unless there is a compelling reason to start a medication immediately. Physicians and patients underestimate the impact these interventions alone can have on lowering your cholesterol, if you work together to achieve specific goals.