My wife went in for routine fasting blood work with her new doc. She has mild hypertension and takes a minimum dosage BP med every day. At age 67, she’s pretty healthy, other than being overweight.
The results of the blood work came back, and the doc’s office called to tell her that her total cholesterol was 174 and triglycerides were at 153. She also told her that the doc wants her to come in so they can prescribe a statin for her to take. WTF? Granted, we don’t know what the HDL/LDL ratio is at this point, but the total number is well within recommended guidelines, and the triglyceride number is at the far low end of borderline category. Why would this doctor want to load her up on statins for numbers that don’t seem to indicate it? Even if there is a history of creeping numbers, it doesn’t seem warranted, and my wife is dead set against taking meds for it.
I would guess the doctor is taking into account all risk factors (high BP, female, over 65’ familial history of heart attack?)
And using some algorithm such as this one…
But, (IMHO) 1) The numbers are near optimal. 2) It was only one test. 3) Modifying diet should come before statins anyway. 4) The normal range for lipid levels are not based on reality anyway.
So, your doctor may feel obligated to prescribe drugs based on what is currently considered good practice. But, your wariness is well justified as well. Statins are really rough on some people, and if your wife does not want to throw another drug into the mix, that seems a sensible choice. More fish oil and a bit less sugar sounds a better plan to me.
The guideline is that those between 40 and 75 years of age with an estimated 10-year risk of heart disease of 7.5 percent or more by that tool should be advised to take a statin. (Or if they already have heart disease, if their LDL is 190 milligrams per deciliter of blood or more or if they’re middle-aged with type 2 diabetes.)
Guessing a systolic of 135 and HDL of 40 she is only at 6%. But put her HDL down to 20 and her BP less well controlled at a systolic of 140 and her risk goes to 15%. So the devil is in the details.
A healthy diet and lifestyle should be done already no matter what the cholesterol number says. More urgency with higher risk numbers okay but she has some hypertension already. The DASH diet plan and exercise is a great combo!
The newer guidelines are indeed widening the net and are not without controversy. But minimally if the calculator results in an over 7.5% risk a sit down conversation with her doctor is indicated.
It’s difficult to not be suspicious of new guidelines that increase the numbers of people taking statins; collusion with drug companies and all that.
We haven’t received the blood work paperwork yet, so I don’t know what the HDL number is, but I’ll be curious to see what the risk factor turns out to be. She’s really adamant about not starting statins, and I don’t blame her, considering some of the side effects like fatigue and muscle pain. I take atavorstatin, and am pretty sure it’s responsible for the vivid and repetitive nature of the dreams I have.
Maybe it doesn’t need to be said, but your wife doesn’t have to do what the doctor says. If the side-effects aren’t worth it, she can say No.
Once you are past a certain age, doctors always want you to take some kind of pill. It doesn’t even need to be anything as venal as being in cahoots with the drug companies - it’s just how they’re trained.
My mother-in-law lived to be 97 on a regimen of making up her own mind about what she was and wasn’t going to do, and treating the recommendations of her doctors as just that - recommendations, not commands. Anecdotal, I know…
Speaking personally, I would rather do what I want and die at 80 than give up my pleasures and die at 83. YMMV.
Or psychobunny, his message to be relayed was: “please get her in for an appointment to talk about statins” and it was either then passed along or understood as “so we can prescribe a statin.”
IF the specifics are that she stratifies to over 7.5% ten year risk then having that conversation, explaining her current 10 year risk and possible means of responding to that risk (including the possibility of a statin) is indicated. (More playing with the tool puts her at 9% with an HDL of 30 and systolic BP of 140 - both very reasonable numbers to guess.)
Again ChefGuy the point of the visit (assuming she does stratify above 7.5%) is not likely to hand off a statin script - that would not require a visit, it could just be set to the pharmacy - but to go over the results and what they do and do not mean, to explain current understanding of what these numbers imply about her risks, and to discuss the plan going forward including the possibility of statin use. If say she does have the numbers I just made up, systolic BP of 140 and HDL of 30, then very seriously the DASH eating plan (Dietary Approaches to Stop Hypertension) with a modest increase in exercise might be an effective approach that she’d prefer. It is both associated with an improvement in BP control and improved lipids - moving a even a fairly modest amount on both would have a huge impact on the ten year risk calculation.
My husband’s grandmother was a tiny lady and in her 90s when her doc decided she needed to be on cholesterol meds. She was of a generation when the doctor’s word was law, so she complied without question. I think if I make it to my 90s, I’m going to do whatever I want!
Also keep in mind that the evidence that statins increase life expectancy is not very good. Even when it reduces the incidence of stroke and heart attack, it does not seem to increase lifespan - go figure. (Cite.) Even studies that indicate that they do, the effects are rather modest, on the scale of six months or so, andin other studies, apparently a 14% reduction in mortality is due to reductions in non-cardiovascular death.
As mentioned earlier, it does not sound like your wife’s doctor is automatically prescribing statins for her, which is much to his credit. Here as always, people can and should make up their own minds about their health care after considering the possible benefits against the risks.
I’m sure you’re correct, and that she just reacted badly to the information as presented by office staff, particularly since the woman who called seemed perplexed as to why, with numbers that low, she should see the doctor. I think part of the reason her numbers are somewhat elevated from previous visits is that she’s spent the last three months recovering from a very bad ankle sprain. We’re just now getting back into regular walks and covered three miles yesterday. She’s very good about eating a lot of veggies and fruits, prefers fish to meat, etc., but does have a large penchant for sugar, and tends to over-salt her food.