Once you hit 50, it may seem like just about everybody you know has his or her prescription for Lipitor, Lescol, Mevacor, Pravachol or Zocor. And across America, the number of people taking this class of cholesterol-lowering drugs known collectively as "statins" is about to reach 14 million. That's a lot of pills. More importantly, that's a lot of dangerously high cholesterol readings driving the demand in the first place.

In fact, patients who are at high risk for coronary artery disease or who already have it make up the lion's share of people who are taking statins. In evaluating whether you should be taking a statin drug, your doctor will consider the criteria which follows below.

Statin Drug Criteria

Elevated LDL ("bad") cholesterol levels between 130 and 159 are considered "borderline high risk;" levels between 160 and 189 are considered "high risk;" levels of 190 and above are considered "very high risk". However, for people with confirmed coronary artery disease, even a level above 130 is considered "high risk."

Elevated total cholesterol levels between 200 and 239 are considered "borderline high risk" and levels above 240 are considered "high risk." Additional risk factors for coronary artery disease include smoking, diabetes, high blood pressure, obesity, lack of exercise and family history, as well as confirmed presence of coronary artery disease especially for those who have already had a heart attack.

Atorvastatin
Lipitor - The most potent statin on the market; most commonly prescribed.

Simvastatin
Zocor - The second strongest on the market; strong clinical trial evidence of effectiveness.

Fluvastatin
Lescol - Less potent.

Lovastatin
Mevacor - Strong clinical trial evidence of effectiveness.

Pravastatin
Pravachol - Strong clinical trial evidence of effectiveness.

Who's Not Taking Statins?

"Not all patients with undesirable cholesterol levels need to take statins or one of the other cholesterol-lowering drugs on the market," explains Uniontown Hospital Cardiologist Dr. David Murello. "Many patients with elevated blood cholesterol who do not show any other signs of heart disease are often first prescribed a program of diet, exercise and weight loss to bring levels down." National Cholesterol Education Program guidelines recommend at least a six-month regimen of reduced dietary saturated fat and cholesterol, together with regular physical activity and weight control as the primary treatment before resorting to drug therapy.

What Do I Need to Know About Statins?

"The good news about statins is that they have been shown to be extremely effective in lowering cholesterol," says Dr. Murello. And recent studies have shown that lowering cholesterol can prevent heart attacks and strokes by as much as 30 percent.

Dr. Murello explains that another plus is that statins are generally well tolerated by most people and side effects are minimal compared to other drugs. The following list of possible side effects can give you an idea of what you may experience:

• Most common: gas, nausea or upset stomach.
• Less common: headache, dizziness, rash or sleep disturbances.
• Possible muscle disorder producing muscle weakness and occasional pain in 1 out of every 1,000 patients.

In general, your doctor will decide which statin to prescribe based on three factors: effectiveness in reducing cholesterol, effectiveness in clinical trials and cost. "To a large extent, however, statins are often used interchangeably," says Dr. Murello. "There are situations where a drug may be highly effective in one person but not as well tolerated by another. In the case of intolerance, we usually just switch statins and the problem often goes away."

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