Is anyone out there still ignorant about cholesterol? Heart UK thinks that there may be: living in a cave, maybe, or up a tree.

Since the 1950s a clear link has been established between cholesterol levels and heart disease. For a long time, however, that’s all it was. Cholesterol levels can be cut by improving diet and taking more exercise, but it is demanding work. Outside clinical trials, there was little evidence that real people living real lives could make much of a difference.

For most people, changing diets meant substituting Flora for butter. No criticism of the product, but this change alone wasn’t going to transform the picture. More puzzlingly, drugs that cut cholesterol didn’t actually reduce death rates. They reduced heart deaths a shade, but overall they made no worthwhile difference. Then along came statins. Suddenly the cholesterol counters were on to a winner. Statins do work: they reduce cholesterol levels markedly and cut overall death rates, too. The side-effects are, for most people, negligible.

Providentially for the NHS, the really persuasive evidence emerged as one of the statins, simvastatin, was going out of patent. So we had the unusual situation of a “new” drug — actually rather an old one — that was both very effective and very cheap. This is like a hole in one in

golf. Millions of people are now on statins, but that isn’t enough for the true enthusiasts. They won’t rest until we all are. And they also want to lower the cholesterol target, which will mean even more prescriptions for even more people, or bigger doses for those already taking the drugs. “Target creep” of this kind is increasingly common in medicine. It suits the drug companies because it widens the market and enables them to sell more branded products, which tend to be more modern and more powerful than those that are out of patent. So it is with statins.

The new targets may be unachievable with simvastatin, even at the top dose of 40mg. It’s hard to argue with the evidence, even though some patients may feel that they are being diagnosed as ill to suit somebody else’s target, or to provide somebody else’s profits.

Feeling fine? Let’s give you a blood test and quickly prove that you aren’t.

It is certainly odd and slightly alarming that two thirds of British adults should be defined as unwell enough to be medicated, based simply on the lipid levels in their blood. But that’s what the evidence tells us, and Heart UK is quite right to conclude that more lives will be saved if we do something about it.

The problem is that within about a year, half of those who are prescribed statins will have given up taking them. Compliance with all medicines is low, but with those that have no perceptible effects it is lower still. You can take a horse to the water, but you can’t make it drink.

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