The Curious Case of Cholesterol Meds

What to do about your cholesterol?  That’s a rather complicated answer now-a-days! First, if you have diabetes or have known coronary artery disease, the answer is pretty clear: get on a statin med (statins are a class of cholesterol meds that include Lipitor, Zocor, Pravachol, Crestor and their generics) and make sure your bad cholesterol (LDL) is under 80.  If you don’t, well, let’s have a conversation.

For those with high cholesterol that can’t be controlled with exercise and diet, medicines have been the answer and have been prescribed now for years.   If one medicine didn’t work, time to increase the dose, change to another med, or add a second medicine from a different class.   The common thought in medicine was that anything that could get the cholesterol lower was a good thing and was good for patients.  However, in the past couple of years, we’ve found that some meds that lower cholesterol don’t lower risk for heart disease (niacin) or may even increase the risk (Zetia).  We’ve also found that for those with very little risk for heart disease, the benefits of any medicine at all may be very small.  

First, if you’re older than a teenager you really should know your cholesterol and have had a discussion with a medical professional about what it means.   If you’re already on cholesterol meds and you are not diabetic or have no known heart disease, please visit with your doctor and discuss with him your overall risk for heart disease and the relative benefit you would get from medicine.  There are calculators that can be used to determine that risk. It may be that you are getting a big benefit from the meds, or it may be that you are not.

Let me give you an example of a middle aged man with whom I’m very familiar (Ok, it’s me, and I’m sharing some pretty personal information – hopefully that won’t be used to steal my identity!)  My most recent total cholesterol was 209 with a good cholesterol (HLD) of 39 and a bad (LDL) of 156.  I’m not very proud of these numbers and in the past would have been inclined to discuss cholesterol meds with someone with similar findings.  However, where I have very few risk factors other than a sub-optimal cholesterol panel, my 10 year risk for some type of heart event is only 8%.  If I were to go on cholesterol meds and get my levels to more optimal ranges, I could decrease my 10 year risk to 5%.

So, let’s see.  With meds I have a 92% chance of not having an event in the next 10 years, and with the meds I would have a 95% chance of not having an event.  Are the costs (prescriptions, office visits, labs) and potential side effects (muscle aches, memory effects, liver inflammation)  worth that extra 3%?  I thought not and have been involved in an aggressive exercise regimen and improved diet (still struggling with chocolate). 

Don’t get me wrong.  I am a strong believer in medication for cholesterol and for many it is truly a life or death issue - please don’t change any of your meds without first discussing them with your doctor!  But in addition to your cholesterol number, you need to know your risk in order to determine if meds are right for you.  And remember, exercise and a healthy diet are always helpful in preventing heart disease!  The side effects (more energy, increased stamina, better self-esteem, lower risk for other diseases) aren’t bad either!  Until next time, keep on moving and stay out of the pantry!

Eat More Fish!