Second Opinions October 12, 2001January 26, 2017 Georgia McGrath: ‘Andrew, shame on you! Get out there and go for a walk each day, and make a few semi-slavish dietary sacrifices – and you won’t need to take the Lipitor! (Did you read the fine print that came with it, about the possible side effects?)’ Jack Kouloheris: ‘I’m 41 and have been on Lipitor about 3 years now, mainly because of a family history of heart disease. I got the same amazing results. It’s Magic! The only downside is that you do have to have periodic liver function tests to make sure no damage is occurring. Then there was the famous stock price crash that happened to Bayer when their Baycol drug, in the same class as Lipitor (a statin), caused potentially deadly muscle damage and had to be withdrawn. Lipitor makes literally billions for Pfizer.’ Dan Stone: ‘I am an internist. The heart scan test is a worthwhile test, but useful only in the context of overall risk. In other words, the implication of your column that anyone with any degree of positivity on a scan would benefit from Lipitor is not correct. Cholesterol is only one risk factor for coronary artery disease. Others include smoking, hypertension, male sex, a family history of early heart disease and age. Homocysteine (a blood amino acid) probably plays an important role–perhaps as much as cholesterol–and others such as depression, “type A” personality, etc., likely do as well. ‘Lipitor does have side effects and the medications in its class have been out for all of about twelve years. Although a fabulous tool for treating coronary disease, its role in otherwise low risk persons with elevated cholesterol remains to be clarified. Your life expectancy is probably several fold greater than the time that these drugs have been available and Lipitor is one of the newest. You are looking at decades taking a drug for which long term data simply does not exist. Is that risky for an otherwise healthy person? The answer is pretty obvious. ‘You know enough about ‘if it’s too good to be true…’ to know that there is more to this issue than taking Lipitor and not worrying. At least six months of dietary therapy would be appropriate prior to considering a drug like Lipitor. After all, what’s six months when we’re talking about treating you for the rest of your life? Also, if you get a physiologic as opposed to an anatomic test (a treadmill), data shows that a normal study (if you achieve target heart rate) confers a five year mortality rate near zero due to cardiovascular causes. So you may not need to worry about a rogue twenty percent lesion in one vessel. The risks of it are probably very, very low if your other risk factors are controlled. ‘SO: Repeat after me, the health mantra equivalent to dollar cost averaging in no-load mutual funds: ‘diet and exercise, diet and exercise, diet and exercise…’ (Sorry.)’