Questions about treating high cholesterol have been confusing for quite a long time. Recent changes in the guidelines have not cleared away the confusion since some doctors have not embraced the new recommendations.
It is smart for everyone to become familiar with who might need treatment for high cholesterol and who might not. After all, although many people tolerate cholesterol-lowering medicines well, others experience serious side effects. Unless there is a reasonable expectation of benefit, it doesn’t make sense to run the risk of adverse reactions. For healthy older women like this reader, the evidence of benefit is lacking.
Does This Reader Need Treatment for High Cholesterol?
Q. I am a 74-year-old woman, 5’4″ and 118 lbs. My blood pressure runs 120/80. My triglycerides are low. At my latest checkup, my good cholesterol was 80 and my bad was 160.
My new family practice doctor wants to put me on a cholesterol medicine. As I recall, my cholesterol has always been like this: high, with high good cholesterol.
I am trying to convince them I don’t need to take meds for this. I have no other health issues. What do you think?
A. The most recent guidelines from the American College of Cardiology and the American Heart Association have done away with cholesterol targets (Circulation, online Nov. 12, 2013). This was a big change from past guidelines, when doctors were encouraged to get patients’ LDL below 100 (below 70 for people with heart disease). There were no data to support these treatment goals. We wrote about these guidelines when they were first introduced.
Since your good cholesterol is so high and your triglycerides are low and your blood pressure is perfect, it is hard to see how a statin would help you. We are sending you our Guide to Cholesterol Control and Heart Health that discusses nondrug approaches to lowering LDL cholesterol so you can have an informed conversation with your doctor. Perhaps he or she will agree to have you try some of these lifestyle approaches to see if they make a difference. Even if your cholesterol levels do not change, it is not clear that this poses a risk to you since you have no heart disease.
There are people who need treatment for high cholesterol. These are individuals with heart disease, or people who have high blood pressure and diabetes. For healthy people, the benefit of taking a statin-type drug to lower cholesterol might be barely detectable, as we discussed here.
