In 1989, Thomas J. Moore — an investigative journalist, not a doctor — published the book, "Heart Failure: A Critical Inquiry Into American Medicine and the Revolution in Heart Care."
In it, Moore discusses what he called the "Cholesterol Myth," a theory that contends diet has little, if any, effect on cholesterol levels; medication that can lower cholesterol can be fatal; and there is no evidence to suggest that lowering cholesterol can lengthen one's life.
The doctors, scientists and drug companies that refuted Moore's claims were in cahoots, a "Cholesterol Mafia," he called them.
Dr. Antonio M. Gotto Jr., the Stephen and Suzanne Weiss Dean and professor of medicine, wasn't surprised to see his name included in that group.
"With a name like Antonio Gotto, you kind of expect it," Dr. Gotto said recently during a lecture he gave on statins and stroke prevention at the Department of Neurological Surgery Grand Rounds.
Dr. Gotto, a leading authority on statins and a renowned lipid researcher, discussed the latest research on statins in the prevention of atherosclerosis and stroke. The numbers illustrate statins are quite effective in preventing a first stroke, but less so against recurring strokes, he said.
As a tool of primary prevention, statins have been shown to both slow the progression of atherosclerosis and reduce major coronary events and procedures. With patients that have pre-established coronary conditions, Dr. Gotto said statins can reduce stroke and death.
Dr. Gotto cited a study of lovastatin that, over the period of five years, lowered the risk of a first acute coronary event by 37 percent.
Another study, conducted on 20,000 patients in the United Kingdom, showed that simvastatin reduced the risk of a first stroke by 25 percent.
But the future of statin research, Dr. Gotto said, will focus on secondary stroke prevention and the possible treatment of other neurological disorders.
The SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) study, conducted two years ago, showed that 80 milligrams of atorvastatin versus a placebo reduced the risk of stroke by 16 percent in patients that had already suffered at least one stroke.
"Even though statins do help with recurring stroke, the evidence is weak compared to occurrences of first stroke," Dr. Gotto said.