Unchain My Heart

By Michael Lemonick

Until last week, I didn't worry much about heart disease. Although heart attacks, angina and cardiac arrest can strike without warning, the odds are in my favor: I'm not overweight, I don't smoke, my blood pressure is good, I eat a low-fat diet, and I get plenty of exercise. While my grandfather had a heart attack at 60, he lived to be 86. And my father, now 75, hasn't had any cardiac problems at all. My total cholesterol is just a little high at 200. My only real risk factor is (deep sigh) age: a few months from now, I'll turn 45, which, the experts say, pushes the danger up a notch. But I can't do much about that.

Last week, though, the Journal of the American Medical Association published a study that's forcing me to reconsider. It turns out that as many as 6 million Americans could reduce still further their already low risk of heart disease by popping lovastatin, a relatively new cholesterol-controlling drug manufactured by Merck. The big question for each of us, of course, is whether we are among the 6 million.

Strictly speaking, the only people who should be asking their doctors about lovastatin are those who resemble the 6,605 people in the study. The men ranged in age from 45 to 73; the women, 55 to 78 and postmenopausal. Those suffering from obesity, diabetes and high blood pressure were excluded. Beyond that, only a few had LDL, or "bad" cholesterol, levels above 190, until now considered the trigger point for prescribing anticholesterol drugs.

Results: after five years, subjects on lovastatin had lowered their bad cholesterol and other dangerous blood-borne fats and had boosted their HDL, or "good" cholesterol. And they had a 37% lower incidence of serious heart disease than those who were given placebos, or pills without lovastatin. Though I'm technically too young to qualify, I'm pretty close, and I'm sure the drugs would lower my cholesterol too. I'd be crazy not to start on lovastatin at once. Right, Doc?

Well, maybe not. For one thing, it would cost more than $1,000 a year. And the drug has potentially serious side effects, including possible liver and muscle damage, both of which could be aggravated the longer I take the stuff. Neither factor would necessarily outweigh lovastatin's benefits. But consider this: while lovastatin reduced "acute major coronary events" more than a third, 90% of those in the placebo group didn't develop such major heart problems either.

So is lovastatin worthwhile for someone like me? It probably would help me live longer, but there's as yet no direct evidence of that or of how much longer. It might turn out that I'd spend a lot of money and suffer side effects in order to add a few months to my life. And if I could lower my cholesterol just by popping a pill, I might be tempted to order that bacon cheeseburger and to sleep in rather than exercise before work, thus negating the drug's benefits.

I think I'll pass. After all, there are plenty of ways to reduce my cholesterol without resorting to drugs. You can bet Merck will be doing further studies to see if people like me would be wise to start taking preventive lovastatin. But for now, I think I'll try to run an extra mile or two each week and cut more saturated fat from my diet. A pill may be easier, but I'd just as soon avoid it if I can.

See Mike's cholesterol tips on the Web at time.com Our regular health columnist, Christine Gorman, is on vacation.