Dr. Roach: When it comes to starting a statin, it’s not all in the numbers
Dear Dr. Roach: I have a question for your column. What is the number of LDL cholesterol that would necessitate taking statins? I am an active 51-year-old female and weigh 126 pounds at 5 feet, 2 inches tall. I eat a healthy diet and avoid trans fat. My total cholesterol is 260, LDL is 173 and HDL is 67. I have had high LDL since I was a teenager. My blood pressure is 123/77. My general practitioner prescribed a low-dose statin (Crestor 5 mg). My cardiologist said that statins will lower my cholesterol but that it does not ensure I will be protected from a heart attack or stroke.
I do not want to take the statin. I have two close relatives who took statins. One suffered from Parkinson’s without a family history of the disease. Another developed diabetes and had a heart attack at 66.
I am on no other medication, and my blood pressure is good. Do you agree with my doctor? How risky is it if I don’t take the statin?
Dear M.I.C.: Statin drugs like rosuvastatin (Crestor) certainly do lower cholesterol, and they do reduce the risk of a heart attack or stroke. Most experts believe that statins exert benefit both through reduction of LDL cholesterol and through other pathways, not yet precisely identified. However, like all medications, they have a risk of side effects.
Diabetes has been shown to develop more quickly in a person taking a statin drug if they are predisposed to getting diabetes. However, there is no clear association between Parkinson’s disease and statin use — in fact, some studies have shown a decreased risk of developing Parkinson’s disease among statin users.
The benefit of a statin depends on how high the underlying risk is for the person. Although your LDL and total cholesterol numbers are high, you are a 51-year-old woman, with a good blood pressure and a high HDL, so your risk of a heart attack, stroke or death from cardiovascular disease is only 1.4% in the next 10 years. I suspect your doctor saw your high LDL number and got nervous. But given your whole picture, the benefit of a statin at this time for you is negligible. So even a small risk of side effects isn’t worth it.
There isn’t a single LDL number that makes a statin necessary. But very high LDL numbers require a different conversation. The decision depends on how much a person wants to avoid a heart attack and how much they want to avoid taking medications. While there is no magic number for 10-year risk that says when a person should take a statin, a 10-year risk of 7.5% is a level that many physicians use to recommend a statin drug for their patients at risk. When risk over 10%, the recommendation should be strong.
Most importantly of all, nearly everyone can improve their risk of getting heart disease by improving their lifestyle. Having a healthy body weight and avoiding dietary trans-saturated fat is a good start, but there are many dietary habits that reduce heart disease risk (and many other risks as well). Regular exercise is as important as a healthy diet.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.