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To Your Good Health: Statin Drugs Are Helpful, Not Universally Needed

Dear Dr. Roach: Why do commercials for cholesterol-lowering medications have a goal of 100 for bad cholesterol? I thought it was 180. I heard a guest on a television show say that everyone over 40 should be on a statin drug. — T.Z.

Answer: Let me answer the second question first. Not everybody needs a statin drug, regardless of age. Statin drugs lower the risk for a heart attack in people who already have blockages in their heart; many studies have proven this. For people without proven heart disease but with a high risk of heart disease, statins also reduce the risk of heart attack. However, since every drug has the possibility of side effects and can be expensive, it is important to use the medication only for people who are more likely to have benefit than a harm. This includes people with diabetes, with blockages in the arteries of the legs and people with multiple risk factors, including high blood pressure, smoking and a strong family history of heart disease.

There is clear evidence that some people with multiple risk factors and a low HDL cholesterol (the good kind — think “H for Healthy”) can reduce their risk for heart attack even with normal total cholesterol levels. Only by taking a full history and exam and looking at cholesterol numbers and perhaps other laboratory data (such as the C-reactive protein) can your doctor or other provider give you the information you need to decide whether to take a statin. Remember also that taking a statin drug is not the only way to lower your risk of heart disease — a healthy diet and regular exercise do that, too.

If a statin is recommended and accepted, the decision of how low to push the LDL cholesterol (the bad kind — think “L for Lousy”) is less controversial, although there still is some disagreement. The standard recommendation is an LDL level below 100, with less than 70 optional for people at high risk. However, some of my colleagues who I respect use the highest tolerated dose, no matter what the LDL is, in order to give the most benefit.

Dear Dr. Roach: My son is 57 and takes a lot of prescription medicine. Among them are Prozac and a medicine for rheumatoid arthritis, which I’m told is a mild cancer drug. My son thinks drinking alcohol does not affect any of the medicines he takes and doesn’t counteract what the medicine is supposed to do. I told him it does, but he won’t pay attention to me. — F.S.

Answer: The greater the number of medications, the higher the likelihood that there will be a significant interaction — with each other, with alcohol or even with food. But just to look at the two you mentioned, Prozac certainly interacts with alcohol, making the alcohol effect more intense: He will be more affected by the same amount of alcohol while on Prozac. The second medication could be methotrexate (just a guess), and methotrexate can cause damage to the liver, and its toxicity is likely much worse with alcohol. I wouldn’t recommend any alcohol for someone on Prozac and methotrexate, and that doesn’t even take into consideration other medications he might be on.