Meds reduce risk, not just numbers

Dear Dr. Roach: You have written many times about elevated cholesterol, but I have never seen anything about low cholesterol. I am an 86-year-old man with Type 2 diabetes that has been treated with moderate success using oral medication. I am 5 feet, 10 inches tall and weigh 160 pounds. I exercise regularly. My total cholesterol has always been low (under 125). Recently it was 103. I have high blood pressure under control on lisinopril and HCTZ. My doctor suggested a statin to raise the HDL. — S.J.Z.

Statin drugs reduce the risk of having a first heart attack in people at moderate to high risk for heart disease. I think of statins not just as drugs that lower cholesterol or raise HDL (although they do), but also as drugs that reduce heart risk when used appropriately. This includes not only people with very high total or LDL cholesterol levels, but also those with low HDL cholesterol levels. It also includes people who are at risk for developing heart disease within the next 10 years.

One major risk for developing heart disease is age. Despite your low cholesterol and blood pressure, your age alone puts you at high risk for heart disease. The diabetes, even if well-controlled, adds additional risk. None of the calculators available can calculate your risk, and they aren’t valid for people over 80.

On the one hand, a statin is likely to decrease your risk of a heart attack. On the other hand, you have gone 86 years without developing heart disease. Further, serious side effects, although still not common, are more common in older people. There is no answer that all experts would agree on, and it is left to the judgment of you and your doctor.

I am more inclined to support a decision to try the medication, while being careful to look for side effects and being ready to stop it if necessary.