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DEAR DR. ROACH: You have written many times about high cholesterol, but I have never seen anything about low cholesterol. I am an 86 year old man with type 2 diabetes who has been treated with moderate success with oral medications. I am 5 feet 10 inches tall and weigh 160 pounds. I exercise regularly. My total cholesterol has always been low (less than 125). Recently it was 103 – with HDL 41 (it has also always been low), LDL 38, 112 triglycerides and total ratio / HDL of 2.4. I have high blood pressure under control on lisinopril and HCTZ. My doctor suggested using a statin to increase HDL. – S.J.Z.
REPLY: Statins reduce the risk of first heart attack in people with moderate to high risk of heart disease. I think of statins not only as drugs that lower cholesterol or increase HDL cholesterol (although they do), but also as drugs that reduce heart risk when they are used in ways that appropriate. This includes not only people with very high total or LDL cholesterol, but also those with low HDL cholesterol. It also includes people who, for other reasons, are at high risk of developing heart disease in the next 10 years. The exact number varies, but most experts recommend statin-based drugs for those at 10-year risk that exceed 10% (some have a 7.5% lower threshold).
One of the main risks of developing heart disease is age. In spite of your low cholesterol and blood pressure, which I suppose are under control, your age alone puts you at high risk for heart disease. Diabetes, even if it is well controlled, adds an extra risk. None of the calculators available can calculate your risk because your total cholesterol is so low and because they are not valid for people over 80 years old. to develop heart disease in the next 10 years at around 50 percent. This could be reduced with treatment, and my best guess is that your risk of taking medications could be about 40%.
On the one hand, a statin is likely to decrease your risk of heart attack. On the other hand, you have spent 86 years without developing heart disease. In addition, serious side effects, although still infrequent, are more common in the elderly. There is no answer on which all the experts would agree, and it is up to you and your doctor to decide.
Finally, it should be noted that some 86-year-olds are "younger" than other 86-year-olds. Since it appears that you are generally well and that you stay active, I would be more inclined to support the decision to try the drug – and if you do, pay attention to the side effects and be ready to stop the medication if necessary.
The important thing is that it is a recommendation, based on the idea that it is more likely to be beneficial than it is harmful. However, the person whose opinion matters most is yours: How do you feel when you take a medication every day to reduce the risk of heart attack and stroke?
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