In our December issue, we told you that the cholesterol-lowering drugs called statins can help prevent heart attacks and boost survival rates in people with heart disease — and not just among people with high cholesterol levels but also those with more moderate levels.

Yet the same researchers who published many of these accolades are now reporting a caveat based on more number crunching: If you have low to average LDL (bad) cholesterol, statins may not help you as much as they help people with higher LDL. The report appeared in the January Journal of the American College of Cardiology.

So if you’re a heart patient with a low to average LDL level, where does this leave you? First, if your doctor has pre scribed a statin, don’t stop taking it. The benefits outweigh the inconvenience and side effects, even if these benefits are smaller than they are for people with higher cholesterol levels.

Second, the fact that you can’t lean entirely on a statin to reduce your risk of a heart attack should prompt you to explore other ways to better your odds. Besides the usual measures, such as aggressively treating high blood pressure and exercising faithfully, there are other avenues for people who need to go beyond the basics.

For example, if your HDL (good) cholesterol is low, you could ask your doctor about taking niacin supplements instead, which can raise HDL. You may also want to ask about testing your level of homocysteine;

This is a substance formed from the breakdown of protein, and some heart patients have too much of it. Homocysteine can be lowered with certain vitamins, but it’s not certain whether this also cuts heart attack risk.

Some doctors may simply prescribe the vitamins, which are safe for most people, and skip the test, which isn’t universally available. Finally, you might consider consulting a cardiologist who specializes in preventive medicine to see if you should be tested for some of the newly identified potential risk factors such as fibrinogen, lipoprotein (a), and triglycerides, and to determine whether you qualify for an experimental drug.

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