"Although the absolute event rates in this group are lower, these are not individuals with ideal health, and major cardiovascular events do occur," Yancy said. "The importance of a 40 to 50 percent reduction in events, i.e., heart attacks and strokes, cannot be ignored, especially when applied to the population at large."
Dr. Cam Patterson, chief of cardiology at the University of North Carolina at Chapel Hill School of Medicine, also supported expanding the criteria for who should be taking statins.
"The number of acute cardiac events that cardiologists see is shrinking compared to five or 10 years ago, and this is driven in large part due to wider use of statins," he said.
But Dr. Merle Myerson, director of Preventive Cardiology at St. Luke's-Roosevelt Hospital in New York, is one cardiologist who believes the move is worrying.
"I remain deeply concerned that this has, in a sense, opened the door to greatly expanded use of statins, especially prior to long-term studies establishing safety, efficacy, good benefit/risk profile, and that it is cost-effective," Myerson said. "I am very surprised that the FDA came out with this -- and rather quickly."
The renewed debate also gave some primary care physicians and other doctors an opportunity to express their continuing concern over the new indication.
"I ... am reluctant to start statins on people who are not at at-least-moderate risk levels, as this really does make them 'patients' for life," said Dr. Eric Larson, director of the Center for Health Studies in Seattle.
Nissen said, however, that the risks of the drugs have been overblown by some.
"Provoking public fear of statins is not good public policy," Nissen said. "There are few therapies with such compelling evidence for benefit."
Still, Dr. Dean Ornish, an author and the director of the Preventive Medicine Research Institute in Sausalito, Calif., said there is at least one "prescription" for heart disease prevention that provides such compelling evidence.
"We have shown in our research, and others as well, that lifestyle factors such as poor nutrition, lack of exercise, chronic emotional stress, and social isolation are underlying causes of chronic inflammation," Ornish said. "Unlike the billions of dollars spent on statin drugs, with the attendant known and unknown side effects ... the only side effects of comprehensive lifestyle changes are good ones."
Yancy agreed that positive lifestyle changes should be combined with drug therapy for the best outcome.
"Any prevention approach must incorporate the proven safe and effective lifestyle adjustments that have already contributed to fewer heart attacks and strokes -- that's step one," Yancy said. "With strong adherence to lifestyle modification, individuals may rid themselves of many current indications for additional prevention measures."