Heart-health screening suggests no need for statin

Dear Dr. Roach: At the end of January I had my yearly physical, and my doctor recommended that I start taking a statin drug. I am a female, 71 years old and take no prescription drugs now. At the end of the physical the doctor told me that I am “very healthy.”

My cholesterol is 212 with an HDL of 39. My blood pressure is 106/60. I chose to have a heart-score screening done for my knowledge. Based on Mesa-risk score, I am in the 64th percentile for age, gender and race with a total coronary calcium score of 55.

I really hate to start on a statin. I have never been on a diet, but the day I left her office I began the Mediterranean diet and plan to continue indefinitely. I am very active and get at least 30 minutes of exercise a day. I believe in doing all I can before taking any type of drug.

I appreciate your time and would very much value your opinion on this matter.

M.J.G.

The calcium score is a test that uses a CT scan to provide information on a person’s likelihood of developing a heart attack. It gives complementary prognostic value to the standard risks, such as your age and sex, cholesterol and blood pressure.

Statin drugs reduce risk for developing a heart attack, but should never be used indiscriminately. The higher the risk of developing heart disease, the greater the value of a statin. There is no single “magic number” that defines when people should get a statin drug. A person’s own preferences, and the multiple other risk factors that aren’t considered by the calculators (especially family history, diet, exercise, stress and relationships) affect the decision. However, the calculators are a place to start. The American Heart Association, American College of Cardiology and others recommend starting statin therapy at a level of 7.5%.

When I put all the information you gave me into the calculator at tinyurl.com/Mesa-risk, I get a 10-year risk of 5.3%.

Given your strong desire to avoid medicine, your new diet and your good exercise, I would not recommend a statin drug for you.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu