The powerful new drug lovastatin isn't intended as a cure-all for everyone who "flunks" an instant cholesterol blood test at the shopping mall. While it can dramatically reduce cholesterol levels by 30 to 40 percent, CHN Director Dr. Scott Grundy urges conservative use of it by physicians. "Lovastatin's rapid development and enormous potential for reducing the risk of heart attacks have been appropriately hailed as a scientific breakthrough, but it can cause undesirable side effects (such as muscle pains, aches, and weakness) in a few patients," explained Grundy. "Patients may push their doctors for it, but I think doctors should recognize they're dealing with a powerful drug here."

In response to a New England Journal of Medicine request, Grundy reviewed the results of lovastatin therapy since its approval by the Food and Drug Administration in October 1987. His guidelines for its use were published in the July 7 NEJM. Among the first physicians to conduct clinical trials on lovastatin, Grundy supervises the treatment of most of the 150 Dallas patients taking the drug for several years. At last count, more than 350,000 American have prescriptions for the drug sold under the brand name Mevacor.

According to Grundy, lovastatin proves most effective in these cases:

In these difficult cases, lovastatin can send cholesterol levels plunging in a matter of weeks. For two rare high-cholesterol conditions, it appears to be the only safe and effective drug. Grundy does not recommend lovastatin for most people with a borderline cholesterol count of 200 to 239 although there may be some exceptions with very high risk patients.

In all cases, diet remains the first weapon against unhealthy cholesterol levels. They physicians may prescribe less potent and more proven drugs such as niacin or bile-acid binding resins. Both have been in use longer than lovastatin.