Cholesterol numbers are not the whole story for stroke risk

Dear Dr. Roach: I am confused about risk for heart attack and stroke for my husband and I based on our cholesterol numbers and risk factors. We are both in our 60s, never smoked, have normal blood pressure, nondiabetic and occasional drinkers. I am normal weight, eat well and exercise, but my cholesterol creeps up each year. It is 240. My husband is 60 pounds overweight and is sedentary with a poor diet. His cholesterol is 159. He assumes he has a free pass based on his low cholesterol, and I assume I could be doomed despite my efforts. What gives? — Anon.

Dear Anon: Men and women have very different risks. I estimated your risks of having a heart attack or stroke in the next 10 years. For your husband, his 10-year risk is 10.5%, while yours is 4.7%. Part of this difference is your protective HDL level of 77 you noted, but much of it is that women are at lower risk than men. Your husband’s risk is higher due to sedentary lifestyle and poor diet, while yours may be even lower.

Although a statin drug would be expected to decrease your husband’s 10-year risk by about 1.7%, I think that he could get benefit by improving diet and exercise. Weight loss in absence of better diet and exercise has a small impact on heart attack risk; it’s more important for him to eat well and exercise, even if he doesn’t lose a pound.

A normal total and LDL cholesterol is helpful, but there are many other risk factors. Almost 75% of people with a heart attack had cholesterol levels that appear low risk. It’s critical to look at risk factors in the context of a whole person. He would do well to try to eat and exercise like his wife, but getting his doctor’s OK to start an exercise plan is prudent.