"Two studies published Tuesday lend support to controversial new cholesterol httphealth.nytimes.comhealthguidesnutritioncholesteroloverview.htmlinlinenytclassifier guidelines that could vastly increase the number of Americans advised to take cholesterollowering drugs called statins. One study suggests that the new guidelines are better at identifying who is truly at risk of a heart attack and should be given statins than the older guidelines are. The other suggests that treating people based on the new guidelines would be costeffective even with the tremendously increased use of statins. The new studies are not large clinical trials that will definitively settle the matter of whether to expand drug treatment to millions more people in hopes of preventing cardiovascular disease the leading killer of Americans. But they could help dispel some of the criticism of the new guidelines and strengthen the position of those who contend treatment should be extended to more people. There is no longer any question as to whether to offer treatment with statins for patients for primary prevention and there should now be fewer questions about how to treat and in whom said an editorial httpjama.jamanetwork.comarticle.aspxarticleid that accompanied the publication of the studies in JAMA a journal of the American Medical Association. The editorial was written by Dr. Philip Greenland of Northwestern University who is also a senior editor of JAMA and Dr. Michael S. Lauer of the National Heart Lung and Blood Institute. Advertisement A study http published last year estimated that  million American adults or almost half those age  to  would be advised to take statins under the new guidelines compared with . million or . percent under the old ones. In actuality about one in four adults of that age now take statins according to the Centers for Disease Control and Prevention http The guidelines httpscirc.ahajournals.orgcontentearly.cir...a issued by two leading cardiology societies in November  move away from trying to lower cholesterol to particular target levels. Instead patients are urged to consider statins if they have an overall risk of . percent of developing a heart attack or stroke httphealth.nytimes.comhealthguidesdiseasestrokeoverview.htmlinlinenytclassifier in the next  years. The risk can be calculated using an online tool httptools.cardiosource.orgASCVDRiskEstimator that considers such factors as gender age race total cholesterol httphealth.nytimes.comhealthguidestestcholesteroltestoverview.htmlinlinenytclassifier systolic blood pressure httphealth.nytimes.comhealthguidestestbloodpressureoverview.htmlinlinenytclassifier and smoking status. The guidelines were contested http almost as soon as they were announced. Critics said that the online calculator greatly overstated http a patients risk of developing a heart problem and that new guidelines would lead millions of additional people to take statins exposing them to potential side effects such as muscle pain httphealth.nytimes.comhealthguidessymptomsmuscleachesoverview.htmlinlinenytclassifier or damage with little to gain. That debate continues with the release of the new studies. These two articles indicate that the new guidelines allow you to treat more people and provide better results at a reasonable cost said Dr. Harlan Krumholz a cardiologist at Yale who was not involved in the studies. But some say the studies have too many shortcomings to be persuasive. I dont think they are terribly informative and I dont think they change our thinking said Dr. Steven E. Nissen the chairman of cardiovascular medicine at the Cleveland Clinic. One of the new studies httpjama.jamanetwork.comarticle.aspxarticleid looked at  people who were not taking statins and who underwent a test for calcium httphealth.nytimes.comhealthguidestestserumcalciumoverview.htmlinlinenytclassifier in their coronary arteries from  to  as part of the longrunning Framingham Heart Study. The authors determined which of those participants would have been eligible for statins under the new guidelines and under the old guidelines. Because it is known what happened to those people over the ensuing nine years the researchers could determine which of the guidelines did a better job in predicting who would develop cardiovascular problems a proxy for who would benefit from taking a statin. As expected many more people were eligible for statins under the new guidelines   percent of the study participants compared with only  percent under the old guidelines. Among the people eligible for statins under the old guidelines . percent had a heart attack or stroke or died from coronary disease over the ensuing nine years. Among those eligible for statins under the new guidelines the figure was . percent almost as high. That suggests that the new guidelines do not lead to treatment of many more people who do not need statins. The people who are new on statins seem to have the same riskbenefit from statins as the ones that are eligible under the old  guidelines said the senior author of the study Dr. Udo Hoffmann the chief of cardiovascular imaging at Massachusetts General Hospital. The study was paid for by the National Institutes of Health. Also only  percent of participants deemed ineligible for statins under the new guidelines had a heart attack or stroke over nine years compared with . percent of those ineligible under the old guidelines. So the new guidelines over all did a better job in discriminating between those who should and should not get statins. Critics said the study did not really test if using statins helped these people. They also said the study was too small for sweeping conclusions. Among other things virtually all the participants were white. The other study httpjama.jamanetwork.comarticle.aspxarticleid found that treating patients who have a . percent risk of heart attack or stroke over the next decade  the threshold for statin use under the new guidelines  was costeffective even though more people would be treated. Under a more generous definition of costeffectiveness it would even be costeffective to give statins to people who have a greater than  percent risk of heart attack or stroke over the next  years a scenario under which twothirds of adults  to  would be taking the drugs. Its good value for money said the lead author Ankur Pandya an assistant professor of health decision science at the Harvard T.H. Chan School of Public Health. The study also funded by the N.I.H. was based on a computer simulation of a representative population of American adults. Like all such studies the conclusions depend on the assumptions made and data chosen. The cholesterol guidelines issued in  do not appear to have altered medical practice much yet. Dr. Michael Blaha director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease said that an unscientific survey conducted for the American College of Cardiology found the adoption of the guidelines was highly variable and not nearly what the guideline writers would have hoped for. Among primary care physicians the new advice has no doubt been even slower to catch on. One sign is that there was no big increase in prescriptions for statins in  according to IMS Health a health care information company. The most widely used statins are the generic equivalents of Lipitor httptopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicslipitor_drugindex.htmlinlinenytclassifier and Zocor httptopics.nytimes.comtopnewshealthdiseasesconditionsandhealthtopicszocor_drugindex.htmlinlinenytclassifier."