They and their colleagues report on PROVE IT results in the April 8 issue of the New England Journal of Medicine. In an editorial accompanying the report, Eric Topol of the Cleveland Clinic Lerner College of Medicine points out that an estimated 36 million people in the United States "should be taking a statin, but only 11 million are currently being treated. Worldwide, the discrepancy is even more staggering; more than 200 million people meet the criteria for treatment but fewer than 25 million take statins."

One reason is cost. A starting dose (10 mg) of atorvastatin costs about $900 a year; the 80 mg. superdose runs around $1,400 a year. Cannon claims such costs are overridden by the benefits, by a reduction in heart attacks and hospital visits for things like clearing plaque from arteries and for bypass surgery. "I think it's one of the best values in medicine," he says.

Side effects

To get and keep cholesterol down, people may have to take statins for most of their lives. What about possible side effects? Postmenopausal women were advised to take estrogen and other hormone replacements to prevent heart attacks. But studies now show that long-term use of these drugs both fail to protect against heart disease and raise the risk of breast cancer.

Braunwald believes the statin study sits on a much firmer scientific base than hormone replacement ever did. He also feels that many doctors have shared the experiences that he has. "I have been prescribing these drugs since 1987," he says. "I find them to be safer than we first thought."

Cannon describes statin side effects as "mild and reversible." Some people may get muscle cramps. Others may develop severe liver or muscle abnormalities, but that is rare and disappears when they stop taking the drug.

Neither Braunwald nor Cannon thinks that statin pills should be used as an excuse for not exercising or eating a healthy diet. "You can have diabetes, high blood pressure, and be obese, even if your bad cholesterol is at a good level," Braunwald points out. "Smoking can give you lung cancer even if your cholesterol is low. Statins should be part of a healthy lifestyle for patients with coronary heart disease, not a substitute for it."

"People with high cholesterol should not feel guilty, should not think they're doing something wrong," Cannon adds. "Genetics is, by far, the main cause of it, and it's now very treatable. Forget about trying to lower your cholesterol with Cheerios, and ask your doctor about statins. They're a terrific way for people with high cholesterol to prevent heart attacks and coronary death."