"A study published Monday is pushing back against the notion that up to  percent of Americans should be taking statin drugs to reduce the risk of heart disease. The study httpannals.orgaimarticledoi.M in the Annals of Internal Medicine argues that current medical guidelines havent adequately considered the risks from these widely used drugs. Some harms are mentioned but its entirely unclear how they were considered when coming up with the recommendations says Milo Puhan https a physician and epidemiologist at the University of Zurich and senior author of the new study. In our approach we very explicitly considered the harms. Its important to note that statin drugs httpsmedlineplus.govstatins.html are generally safe and harms are uncommon. On the other hand the benefits arent that great either. Anywhere from  to  healthy httpsascpt.onlinelibrary.wiley.comdoifull.cpt. people need to take a statin daily to prevent a single heart attack for five years so even small harms may outweigh the potential benefits the Swiss scientists say. The most common side effect of these drugs is muscle pain which usually goes away if patients stop taking the medicines. People taking statins are also at a higher risk of developing diabetes which is harder to reverse. Puhan also found that some statins were more effective than others with atorvastatin the generic name for Lipitor being the best of the bunch. He notes that physician guidelines dont generally compare the relative value of these drugs which are all available as inexpensive generics. He also finds that benefits fade compared with harms as people get older. The elderly do not benefit as much as previous studies might have thought he says. One size doesnt fit it all he concludes. Thats a very important message. Puhan says based on his assessment perhaps  to  percent of older adults should be taking statins  far less than the  or  percent suggested by current medical guidelines. I think for me as a physician says Ilana Richman httpsmedicine.yale.educorepeopleilana_richman.profile an internist at the Yale School of Medicine this kind of data suggests that if we give more weight to the potential for adverse events then maybe its reasonable to hold off for lowerrisk patients. She cowrote an editorial httpannals.orgaimarticledoi.M about the paper and came away from it thinking that doctors need to spend more time talking about the plusses and minuses of statin treatment personalizing their recommendations more than they do now. She says its a challenge to convey these sophisticated concepts in the short amount of time doctors have to spend with their patients. Yet that kind of dialog is increasingly the expectation. In midNovember the American Heart Association and American College of Cardiology published new guidelines https calling for more nuanced conversations around who would most benefit from statins. Scott Grundy https a physician at the University of Texas Southwestern Medical Center who chaired the guidelines committee says the new recommendations urge people in this gray area to get a special kind of CT scan that looks for calcium deposits in heart arteries a signal for clogs that could cause trouble. If you have no coronary calcium then your chances of having a heart attack over the next  years are very low he says. And it turns out that perhaps  percent of people who are identified as candidates based on their risk factors such as cholesterol levels and age actually have clear heart arteries Grundy says. That means a lot of people are going to be treated unnecessarily if they dont have the calcium scan. But that test which Grundy says is available for about  is controversial among some physicians. They worry that it will trigger overtreatment of conditions that the scan will pick up but which dont require urgent attention. And it is only useful as a screening test for people who havent had heart disease. Statins are routinely prescribed for people who have already had a heart attack or stroke. For those patients who werent included in the Swiss analysis the benefits are so clear its almost mandatory to be on a statin drug Grundy says. He disagrees with a lot of the particulars in the Swiss study. So does cardiologist Roger Blumenthal https who heads the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins. The harms analyzed in the paper can be dealt with by a smart clinician he says. Yet both the new guidelines and the latest study agree on an important point Doctors and patients should spend more time reviewing the benefits and risks of statins with attention paid to each persons particular circumstances."