Modern medicine has developed striking ways to treat coronary heart disease, which feature coronary stents implanted percutaneously and coronary artery bypass grafts performed surgically with the aid of a heart-lung machine. And then there are statins to lower cholesterol.

A 70-year-old man sees a physician for a checkup. He has no history of heart disease and no risk factors for it. He does not smoke, has no family history of diabetes or heart disease, and is physically active and not overweight. His blood pressure is 130/70. A lipid panel, however, shows that his calculated low-density lipoprotein cholesterol (LDL-C) is 195 mg/dL. Following the most recent 2013 guidelines framed by an American College of Cardiology (ACC) and American Heart Association (AHA) task force, the physician prescribes a statin for this person, rosuvastatin (Crestor) 20 mg/day, for primary prevention of atherosclerotic cardiovascular disease (ASCVD). [1]

Cardiologists declare that "cholesterol-containing lipoproteins are central to the pathogenesis of atherosclerosis." [2] Statins, first approved for clinical use in 1987, are very effective in lowering cholesterol. High intensity statin therapy, rosuvastatin 20mg/day and atorvastatin (Lipitor) 40-80 mg, reduces LDL-C by 50 percent or greater. Moderate intensity therapy, rosuvastatin 10 mg, atorvastatin 10 mg, simvastatin (Zocor) 20-40 mg, and pravastatin (Pravachol) 40 mg/day, achieves a 30 to 50 percent reduction of LDL-C. [3]

Some 43 million Americans take statins. [4] In 2010, 11.6 percent of the population took them, 37 million, which includes 19.2 percent of people age 45-64; 39.6 percent, age 65-74; and 44.3 percent of people age 75 and older. [3] Following the 2013 ACC/AHA guidelines, an additional 10.2 million Americans without cardiovascular disease, like the patient above, have now become candidates for statin therapy. [5] One study concludes that 97 percent of black and white Americans aged 66 to 75, including all men in that age group should take statins. [6]

It is a multi-billion dollar business. Pfizer's Lipitor went on sale in 1997 and became the best-selling drug in the history of prescription pharmaceuticals before its patent expired in 2011. Sales surpassed $125 billion. AstraZeneca's Crestor was the top-selling statin in 2013, generating $5.2 billion in revenue that year.