Cardiologists agree that we should all be getting regular exercise and eating a healthful diet with lots of vegetables and fruits. But they don’t agree on which of us should be taking statins to protect our hearts. Just how much do these cholesterol-lowering drugs actually reduce the risk of a heart attack? The answer to the statin standoff is surprisingly controversial.

Lowering Cholesterol Beyond Statins:

Dr. Steve Nissen, chair of cardiology at the Cleveland Clinic, is on the pro side of the statin standoff. He also explains the results of the FOURIER study of evolocumab (Repatha). The study was published in the May 4, 2017, issue of The New England Journal of Medicine.  This new medication lowers LDL cholesterol far more than any previous drug could. The study showed evolocumab reduced heart attacks and strokes, but it did not protect people from premature death.

A Statin Skeptic:

Dr. Rita Redberg, a cardiologist at the University of California, San Francisco, and editor in chief of the prestigious journal, JAMA Internal Medicine, remains unconvinced that statins help healthy people. (People with heart disease are another story.)

She helps us understand why the statin standoff is so controversial. Just how much do statins help? Dr. Redberg explains the statistics. She is convinced that we all need to know about the pros and cons of statins so that we can be informed when we participate in making an informed decision about whether or not to take one.

Heart Failure:

Heart disease, characterized by clogged arteries and heart attacks, is only one of the threats our hearts may face. Dr. Alan Maisel of the University of California, San Diego, explains the distinction between heart disease and heart failure. What are the symptoms that signal heart failure? How can it be treated?

Only a portion of our conversation with Dr. Maisel could be included in today’s show. If you are interested, we offer the entire interview here.

Those who are interested in heart failure may wish to consider a recent article in The New England Journal of Medicine (July 6, 2017): Declining Risk of Sudden Death in Heart Failure. The authors report that sudden death has declined substantially since 1995 among people with heart failure participating in clinical trials. They attribute this drop to increased use of evidence-based medicines.

This Week’s Guests:

Steve Nissen, MD, FACC, chairs the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic’s Sydell and Arnold Miller Family Heart & Vascular Institute. He has served as president of the American College of Cardiology and chair of the CardioRenal Advisory Panel of the Food and Drug Administration. He is the co-author, with Mark Gillinov, MD, of Heart 411: The Only Guide to Heart Health You’ll Ever Need.

Rita Redberg, MD, FACC, MSc, is Professor of Medicine at the University of California, San Francisco. She is a cardiologist and Director of the UCSF Women’s Cardiovascular Center. Dr. Redberg is the editor of one of the world’s pre-eminent medical journals, JAMA Internal Medicine. She has written some provocative articles with colleagues about saturated fat, cholesterol and statins. Her editorial in JAMA Internal Medicine, “Statins for Primary Prevention: The Debate Is Intense, but the Data Are Weak,” reflects the statin standoff.

Alan Maisel, MD, is Professor of Medicine at the University of California, San Diego and Director of the Coronary Care Unit and Heart Failure Program at the Veterans Affairs San Diego Healthcare System. Dr. Maisel’s seminal research on BNP was published in The New England Journal of Medicine, July 18, 2002.

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