The tailored strategy treated fewer individuals with high-dose statins and saved 500,000 more quality-adjusted life years.

"The bottom line message - knowing your overall heart attack risk is more important than knowing your cholesterol level," Hayward says. "If your overall risk is elevated, you should probably be on a statin regardless of what your cholesterol is and if your risk is very high, should probably be on a high dose of statin," the U-M physician says.

"However, if your LDL cholesterol is high, but your overall cardiac risk is low, taking a statin does not make sense for you," Hayward says. "If your cholesterol is your only risk factor and you're younger, you should work on diet and exercise."

Research has increasingly emerged questioning the value of cholesterol targets and which of statins mechanisms is most important to preventing cardiac events. Cholesterol-lowering drugs work by blocking a key enzyme linked with LDL cholesterol production, but they initiate other changes in the body.

"Statins also affect inflammation on the inside of our blood vessels which is often what causes heart attacks and strokes - it's not just a matter of cholesterol alone," he says.

University of Michigan Medical School and VA Ann Arbor Health System