Doctors actually have real interest in knowing whether or not what we are doing works.
For example, we know that managing your cholesterol reduces your odds of cardiac arrest, heart attack and stroke. We know this based on a scientific understanding of cholesterol, and also by the fact that we have reduced the occurrence of heart attack and stroke by about half over the past 20 years, which is pretty fantastic. We treat heart attack and stroke more effectively than in the past, but it's certainly better to just not have one at all!
Also, we know that diet has a part to play in helping with your cholesterol and have been making recommendations about diet and not just medications for years.
On the other hand, when we re-examine things and come up with better or different ideas we look closely at these ideas and then come to a consensus as to what to do with the new information. This would be called science.
In that vein (no pun intended, here), two things within the last year or two have come to light and have become widely accepted about cholesterols. One has to do with when to use drugs for high cholesterol, and the other is about diet.
Since the 1990's we have seen that cholesterol lowering through dietary modification, the use of prescription drugs (the so-called 'statins) or both results in preventing cardiac arrests, heart attacks and strokes.
The role of statins has been around your LDL (low-density lipoproteins; the so-called "bad cholesterol"). Specifically, we have seen that you are at 40-44% lower risk of a heart attack or stroke if your LDL is less than 160, under 130 if you also smoke or have high blood pressure, under 100 if you have diabetes, and under 70 if you have already had a heart attack and we are trying to prevent a second one.
The American Heart Association and the American College of Cardiology (a professional organization of U.S. heart specialists) periodically examine efforts to prevent heart attacks and strokes; in other words, is what we're doing working, and can we do better?
Towards the end of 2013, they recommended a really sweeping change in how doctors should use statins (a widely used type of cholesterol lowering medicine since the 1980's). They basically took how we already know statins work to prevent heart attacks and strokes and applied them to already existing ways to determine a person's risk of actually having one over the next ten years in an effort to figure out whether a patient would actually benefit from being on a statin at all, and if so what kind and how much.
These recommendations were widely debated, re-tested and verified, and the bottom line is that they are regarded as valid and beneficial and over the past half a year or so are being put into practice.
So instead of looking purely at a static LDL level, we now use age, gender, blood pressure, your cholesterol results and whether or not you smoke or take blood pressure pills to calculate your risk of having a heart attack or stroke in the next ten years.
If this risk is under 5%, there is no need of using a statin as you are already at low risk and adding a statin isn't going to improve on this. At 5-7.5%, a statin dose sufficient to lower cholesterol by about 25% would reduce risk to less than 5%. At over 7.5%, that's quite high and using a statin capable of lowering cholesterol by about 50% would also cut your heart attack or stroke risk by half.
This is not to take away from the value of eating a healthy balanced diet, exercising regularly and not smoking. It is also not a way to put more people on statins. In fact, this new way of looking at cholesterol test results plus personalized information reduces the overall number of folks needing statins. In other words, the idea is not to use more statins, it's to use them smarter.
All you need to calculate your own risk is your systolic blood pressure (the first, higher number) and your lab results. Feel free to check it out using the above link, or this free iPhone app from the American College of Cardiology (I'm sure there's an Android version, too). There's a lot of information in the app and in plain English. It also is interesting to tweak the numbers a bit to see how much lower your risk would be if you lowered you blood pressure or stopped smoking!
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