18 Sep 2017
Evelyn is 72 years old and has been healthy most of her life. She watches her diet and exercises regularly. Her father, who smoked and was overweight, died from a heart attack in his late 50s. Evelyn has shown no evidence of cardiovascular problems nor any risk of stroke, although she continues to be treated for mild to moderate hypertension, which she developed before retiring from a high-stress job.
Because blood tests performed annually since she was 60 indicate Evelyn has high overall cholesterol, despite a healthy lifestyle, her doctor put her on medication (statin) therapy three years ago. Her overall cholesterol level has since dropped, but she does not like being on continuing medication. In fact, she has read about the possible side effects of long-term statin use. Because she feels great, energetic, she no longer takes a pill every day – just a couple of times weekly.
Should Evelyn be more compliant and take her medicine as prescribed or should she be taken off drug therapy? Frankly, as care providers, we have no simple answer. But overall when taking many factors into account, the answer is yes – Evelyn should take her medicine as prescribed. Across multiple studies of numerous different statins, the general outcome has been that they lower risk of heart disease, stroke, and death related to these causes by 30 to 40%. Evelyn already has an elevated personal risk because of her family history, her age and postmenopausal state, and her personal history of hypertension. Taking statin therapy not only lowers cholesterol levels but lowers the risk associated with these other factors. This is the reason why patients with normal/good cholesterol levels who have had previous cardiovascular events (heart attack/stroke/need for revascularization) show clear benefit from taking statins even though they had good baseline cholesterol levels.
Statins also have favorable effects that go beyond their ability to lower cholesterol levels. They have been shown to decrease inflammation and lower the risk of blood clots. They have been shown to stabilize plaques that already exist in arteries. They have been shown to have benefits in terms of reducing the risk of dementia.
And on top of all of these benefits of statin therapy, it is important to point out that in clinical studies involving tens of thousands of patients, 5% of patients suffered from side effects. These side effects are most commonly myalgias – muscle aches and pains. When caused by statin therapy, it is an indication to adjust dosage or change medication. But now with a number of quality medications available, it is no longer a reason to stop statin therapy altogether. Regarding long-term side effects such as liver disease, today’s statins have been shown to be so safe that routine monitoring of liver enzymes is no longer recommended.
The Centers for Disease Control and Prevention (CDC) cites heart disease as the leading cause of death in women over age 65 and second leading cause of mortality among women ages 45 to 64. High blood levels of LDL and triglycerides, a form of fat, are considered risk factors, according to the CDC. In most women, cholesterol levels rise naturally after menopause because estrogen, which keeps cholesterol in check, decreases.
The information on cholesterol can be conflicting and downright confusing, but my bottom-line recommendations to all seniors with high cholesterol, but minimal other risk of heart disease or stroke, are:
• Work with your physician to develop a health plan that best suits your needs, family medical history and lifestyle.
• Stay informed. Before going on any drug regimen, consider potential benefits and risks.
• Eat healthy. Reduce consumption of foods with saturated and trans fats and increase fiber in your diet.
• Maintain a proper weight. Obesity is linked to development of heart disease, diabetes, arteriosclerosis and even cancer.
• Stop smoking.
• Exercise. Older adults tend to be more sedentary. Make a special effort to increase your activity, even if that activity simply means regularly walking around the neighborhood.
• Do not stop or change how you take any medicine on your own without first discussing it with your physician.
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- what high cholesterol truly means for your health - September 18, 2017