But a panel of experts was unconvinced, and advised the fda last summer to deny the petition, at least until further studies are completed. And so things now stand. In the absence of new clinical trials, the researchers who reported in the British Medical Journal used complex mathematical analyses of four previous studies to conclude that statins can reduce the risk of suffering a heart attack even in men and women with normal cholesterol levels and no signs of heart disease. Since this population is fairly healthy, however, doctors might need to treat 250 or more people to save a single life. A bargain for the one whose life is spared, but not so great for the majority, who would not only bear the expense but would also be exposed to potential side effects from a treatment that might turn out to have been unnecessary.
Many questions remain unanswered.
Researchers have shown, for example, that taking an aspirin a day can reduce a heart patient's risk of suffering a heart attack. Similarly, many cardiologists are impressed by the ability of another group of drugs, called ACE inhibitors, to normalize high blood pressure and reduce the strain on the heart. Dr. Sidney Smith, director of the center for cardiovascular disease at the University of North Carolina in Chapel Hill, predicts that doctors will be much more aggressive in their use of such preventive strategies in the next year or two. There are pretty powerful data that medical therapy can arrest the progression of coronary disease and atherosclerosis and cut down on cardiac events. As always, the art of medicine is in taking that information and figuring out who will benefit most.