Over 70? It might be time for a statin

Dear Dr. Roach: I’m a 71-year-old male in reasonably good health. My primary-care physician suggested I consider taking Lipitor 10 mg. My total cholesterol is in the 150-160 mg/dL range, although my LDL is slightly elevated, and my HDL is slightly low. My usual blood pressure is I have no heart disease or family history of heart disease, am not overweight, exercise regularly and eat a healthy diet.

The only reason my doctor gave me for recommending Lipitor was that I am over 70. He indicated it was up to me. Is the need to take a statin indicated just based on age? I try to avoid taking medications unless it is clearly necessary. — C.L.

Statin drugs reduce the risk of developing a heart attack. The amount of risk they reduce depends on a person’s baseline risk. Although elevated cholesterol levels and blood pressure are risk factors, being 71 and male is your biggest risk factor.

According to validated calculators, your risk of having a heart attack or stroke in the next 10 years is about 19%. Note that your absence of family history, good diet and regular exercise, are NOT considered by the calculator, so the 19% is probably an overestimate of the risk in your case.

Treatment with a statin like atorvastatin (Lipitor) would be expected to reduce your risk by 3.5% to 4% over 10 years, to about 15%. Guidelines would clearly recommend a statin drug, and most would recommend a high dose, 40 mg or so, rather than the low dose your doctor has suggested.

Guidelines are helpful but not right for everyone. There is not a single decision that is right for everybody, and your preferences really do matter. If you don’t mind taking the medication, it would be a reasonable plan to try it. Most people have no side effects, and the cost for generic atorvastatin is small.