You can hardly watch television these days without seeing commercials for statin drugs such as Lipitor and Zocor. They lower cholesterol, which in turn keeps plaque from forming in the arteries, reducing the risk of heart attack and stroke.

We talked to Dr. Theodore Feldman, medical director of Baptist Health's South Miami Heart Center, about how statins work, who should take them and what other factors are at play in cardiovascular disease.

Feldman, a cardiologist, has participated in studies on statins and cholesterol for several decades, and believes the drugs have greatly advanced the fight against heart disease. But, he cautions, that doesn't mean we can forget about other risk factors. Lifestyle changes such as weight loss and exercise are still an important part of reducing cardiovascular risk, he says. His answers were edited for space.

Q: What is the role of cholesterol in heart disease?

A: Cholesterol is an essential component of the structural integrity of cells in the body as well as the chemical basis for steroid and sex hormones. When cholesterol circulates in the bloodstream in excess of what's required, it winds up getting incorporated into the blood vessel wall and begins to block blood flow. If the artery becomes totally blocked, people have heart attacks, unstable angina or sudden cardiac death.

Q: Do high cholesterol numbers always lead to heart disease?

A: Nothing is always, but on a statistical basis, high cholesterol is the most significant relative risk for developing heart disease. Certainly there are people who develop heart disease who have normal or low normal cholesterol, and there are people who don't develop heart disease who have high cholesterol.

Q: Who should take statins?

A: Everybody who is at high risk. That means everyone who has known heart disease, virtually every diabetic, the majority of hypertensives and anyone who has had any evidence of blood vessel blockage, not just in the heart but in the brain, carotid arteries, abdominal aorta and the peripheral blood vessels that go to the legs.

LDLs [low-density lipoprotein levels] below 70 is the target for high-risk individuals, who constitute 35 to 40 percent of the population. About another 40 percent would be at intermediate risk. Those are people who have some risk factors but don't have clear evidence of heart disease. Clearly those people benefit from cholesterol lowering.

We use something called the Framingham Risk Score, which looks at six factors: age, gender, HDL [high-density lipoprotein], systolic blood pressure [the top number], smoking and total cholesterol. In the group that's at intermediate risk, a 10 to 20 percent chance of having a cardiac or vascular event over 10 years, we say they should be treated to LDL levels below 100. If you're a low-risk individual, we would want your [LDL] cholesterol to be below 130.

Q: How do statin drugs lower cholesterol?

A: They block the synthesis of cholesterol in the liver so the liver perceives that it needs more cholesterol and dramatically lowers the cholesterol circulating in the blood.

Q: What are the side effects?

A: Liver-test abnormalities occur in about 1 percent of individuals. The other common side effect is muscle aches or pain, which range from 2 to 3 percent to 15 percent. There is a more significant side in which the muscle becomes inflamed and breaks down and becomes toxic to the kidneys. That occurs in one of every 10,000 to 20,000 patients.

Q: What are other ways to lower cholesterol?

A: Diets that are low in saturated fat are very effective in lowering LDL cholesterol. Plant stanols, spreads like Take Charge, will lower LDL cholesterol by about 10 or 15 percent. Soy protein, oat bran and fiber also will lower cholesterol. [Taken together, these foods can] lower cholesterol by 20 to 30 percent in moderate to high doses.

Q: What has been the impact of statins on the treatment of heart disease?

A: Statin drugs have absolutely changed the face of cardiovascular disease in a similar way to the impact that antibiotics had on infectious diseases in the 20th century. If we go out 50 or 100 years from now or even less, heart disease will no longer be the No. 1 reason why people die in Western societies. I think we have the potential, with aggressive use of lifestyle changes and appropriate medications, to really wipe out atherosclerotic cardiovascular disease, not in my lifetime or yours, but maybe in our kids' or our grandkids' lifetimes.