Statins are the best-selling cardiovascular drugs in the world, and experts estimate that 20 million Americans currently take them. Their development represents one of our greatest achievements in the fight against coronary heart disease. Acting at the level of the liver, statins reduce LDL (bad) cholesterol, and since their release in 1987, they’ve saved many lives.Although we have solid scientific proof of statin benefits, lately these medicines have been the subject of intense controversy and clashes between experts. Let’s explore the battleground.QUIZ: Do You Have a Healthy Lifestyle?Myth: Statins don’t work in womenPointing out that the majority of statin studies focus primarily on men, some claim that we don’t have sufficient evidence to support statin use in women. Critics are correct in their assertion that statin studies enrolled more men than women. But we have data on the impact of statins in tens of thousands of women.And when this data is analyzed, we find that statins do work in women. The drugs reduce their risks of heart attack, stroke and death. As one expert concluded, “…with respect to statin therapy, what is good for the gander is good for the goose.”Myth: You don’t need a statin because you can always lower your LDL cholesterol with diet and lifestyle aloneWhen it comes to lowering LDL cholesterol and either treating or preventing coronary heart disease, we always prescribe a heart-healthy lifestyle that includes a Mediterranean-style diet and exercise. You can lower LDL cholesterol with calorie control and the right foods (limit saturated fat and dietary cholesterol while favoring fruits, vegetables, whole grain offerings and “good” fats). But because most cholesterol is manufactured in the liver, it is difficult to lower your LDL cholesterol by more than 20 percent through changes in diet alone.MORE: Foods That Lower Your Genetic Heart RiskBy all means pay close attention to diet and exercise as a means to control your LDL and raise your HDL cholesterol. But if LDL remains elevated despite your best efforts, don’t be afraid to try a statin.Myth: Statins cause cancerAbsolutely untrue.Myth: Statins cause side effects in most peopleAny medicine can cause side effects. But statins are among our safest medicines, and they rarely cause irreversible side effects. Muscle aches and pains are the most common complaints among statin users. If you take a statin and experience this problem, don’t be discouraged. We can frequently work around it by changing to a different statin or adjusting the dosing schedule.Recent media attention has focused on the link between statins and diabetes. Statins do cause a slight increase in the risk of developing diabetes. But this risk is extremely small and is more than offset by the medicines’ benefits.COLUMN: Does Estrogen Protect Women’s Heart?The most serious side effect of statins is the breakdown of muscle tissue, a disorder known as rhabodmyolysis. Fortunately, this side effect is rare, occurring in about 1 of every 10,000 patients treated with the drugs. When it does occur, however, the consequences can be severe. Patients on statins should immediately report serious muscle pain or weakness, particularly if associated with dark, tea-colored urine. Rapid treatment aids recovery. This complication is more common in those with an underactive thyroid—if you have thyroid problems, make sure that you tell your cardiologist before starting a statin.By the way, those annual liver blood tests in statin patients are probably unnecessary. There has never been a case of serious liver damage attributable solely to a statin.Myth: Statins are too expensiveNot any more. Several statins are now available in generic form. In many patients, a year’s worth of statins costs only about $50.Myth: Statins don’t help people who do not have documented cardiovascular diseaseFew argue with a statin prescription for the person who has suffered a heart attack or stroke or who has had a stent placed or bypass surgery. But what about the person who does not have known cardiovascular disease? Do statins help these people? Some critics answer no. The real answer is a qualified yes: statins reduce the risks of heart attack in stroke in some people without cardiovascular disease.The trick is identifying these people. In general, we recommend statin use in those with elevated LDL cholesterol who are at high risk of developing coronary heart disease. If your LDL cholesterol is 130 or greater and you have two or more risk factors for coronary heart disease, you and your doctor should talk about statins. The risk factors we are talking about include cigarette smoking, high blood pressure, and family history of early heart disease (before age 55 in men or 65 in women). In addition, most diabetics should consider statin use.COLUMN: Heart Disease in Women: An Overlooked IssueMyth: When people take statins, they are free to follow an unhealthy lifestyleA heart-healthy lifestyle is the foundation of heart disease prevention and cholesterol management. The concern is that people will eat poorly, stop exercising and keep smoking, believing that a statin pill each night will erase these missteps.This choice is up to you. Prove that this statement is a myth. Choose wisely!