I know guinea pigs, and I stake no claim that I was one. The real risk-takers at the beginning of the statin era were the brave little band of patients who were in the lovastatin safety trials in 1982. Still, nanoseconds after lovastatin was approved in 1987 and hit the market as Mevacor, Oscar Mann, my cardiologist, pulled out his prescription pad. Let's get that cholesterol down, he said. That was fine by me. My most recent lab results were showing 244 milligrams per deciliter for total cholesterol (no one was talking much about LDL back then), and I wanted no repeat of 1983, when after months of chest pain I finally had open-heart bypass surgery.
Over time, Dr. Mann bumped up the dose and switched me to beefier statins—Zocor in 1994, Lipitor in 1997. Now, after 21 years, no one other than patients in the early clinical trials can claim a longer statin history than mine. And I intend to keep on, even though the recent questions about Vytorin's effectiveness have made some challenge the magic of low cholesterol numbers.
Yet until my editor asked me in the wake of the Vytorin hubbub to consider the consequences of swallowing these powerful pills for so long, I'd barely thought about it. After a cholesterol check, a lab report that showed a commendable number would give me a little prideful rush, like getting an A in a tough course. As if I could take credit for the biochemistry of my statin.
When I opened my thick medical file last weekend, however, I found fewer of those self-congratulatory moments than I'd remembered. A few months before my 1983 surgery, my total cholesterol was 216 milligrams per deciliter, not bad for the time. After being on Mevacor for a couple of years, I was at 227, heading in the wrong direction. New guidelines set "elevated" at 240 milligrams per deciliter for total cholesterol and 160 for LDL, the bad stuff. My total was at the edge, and my LDL of 166 wasn't so hot, either. Another five years passed. The reports show that little had changed. How could this be?
But something seemed to be working. The sections of vein stitched onto my heart in 1983 as bypasses, expected to last about eight to 10 years, held up until 1998—more than 14 years. Then it was more chest pain, and back to the OR for a second bypass, less dramatic than the conventional heart-stopping, chest-cracking technique. The surgeon would work through a small opening between my ribs; the heart would continue to beat. I walked out of the hospital 36 hours after surgery. To my late surgeon, Albert Pfister: Thank you.
Eleven years after swallowing my first Mevacor tablet, my cholesterol profile finally took on a shine: 155 total, LDL of 83. HDL, the good cholesterol, stood at 63, also laudable. Was it the Lipitor? Was I eating better (maybe a little)? Was it the exercise (I wore out three Nordic Track ski machines over the years)? Was it my gritty morning Metamucil? The everyday lunch at my desk of orange segments and yogurt with little pillows of Shredded Wheat mixed in? The over-the-counter HDL-boosting niacin?
My statin dose edged up to the daily maximum of 80 mg. The topmost lab report in the pile is very cheery: 126 total, 62 LDL, low triglycerides. At 50, the HDL is marginal, but I've done about all I can do to pump it up.
I haven't mentioned muscle and joint achiness, because I'm your typical male in denial. I'm almost 63, for pete's sakes. I ache. But I won't listen to my body unless it shouts at me. To make sure my liver is happy and my muscles aren't about to dissolve, I do get my liver enzymes checked every once in awhile. They're always fine. So whatever aches I think I feel, I ignore. I don't necessarily recommend this—it's not exactly listening to your body. It works for me, though, and my last surgery was 10 years ago this month. Maybe it's not just the statin. But I'm not going to mess with a good thing.