Take holistic view of heart attack risk

Dear Dr Roach: I am a 66-year-old male, 6 feet, 3 inches tall and weighing 220 pounds. I am active and fit.

My cholesterol recently has been between 208 and 214 in the past two physicals. My HDL is 54. My doc said it is time for 20 mg Lipitor, as better eating did not lower it as I had hoped. Since I started, my cholesterol is 145.

My girlfriend is also 66, 5 feet 6 inches tall and 135 pounds. She is active with me. She has been taking red yeast rice for years to help with her elevated cholesterol, two pills daily.

During a recent blood test, her cholesterol was around 245-250. Her HDL is 93. Her primary care doctor says not to do anything different, but I’m thinking she should also be taking Lipitor or an equivalent.

Aren’t both men and women’s cholesterol levels recommended to be below 200? Should she talk to her doc again about a Lipitortype medication?

P.B.

Answer: The goal for treating cholesterol is not to make the numbers better; it’s to reduce the risk of a heart attack. Consequently, it’s important to take a holistic view of a person’s risk of having a heart attack before thinking about using a medication. This includes an evaluation of diet, stress and exercise. Family history is an often-neglected risk factor, and there are nontraditional risk factors that most physicians don’t spend enough time obtaining.

Most calculators are unable to synthesize all of these risk factors. The most commonly used ones look at blood pressure, cholesterol, age and sex: putting your information (prior to starting Lipitor) into one of these calculators gives the result that your risk of a heart attack or stroke in the next 10 years is 12.3 percent. With this result, most guidelines agree with your doctor that moderate or even high-dose Lipitor is a good choice for you.

Your girlfriend has the advantage of female sex and a high HDL. This protects her to a large extent, so her 10-year risk is only 5 percent (with the same assumptions about her blood pressure). The guidelines agree with her doctor that no Lipitor or similar medicine is indicated.

Readers may email questions to: ToYourGoodHealth@med .cornell.edu or mail questions to 628 Virginia Dr., Orlando, FL 32803.