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Ask the doctors: Do I really need a statin?

Q. I am a 62-year-old female with no chronic health problems, but I am about 10 pounds overweight. My new doctor wants to put me on a statin immediately. My total cholesterol is 187: my LDL is 129, my HDL is 47, and my triglycerides are 55. He is concerned because my father died of a heart attack from coronary artery disease. The doctor wants my HDL to be above 60 and my LDL to be below 100. Could this result be achieved by weight loss, dietary changes, and exercise alone? If not, which statin would you recommend?

A. It’s wonderful that you and your physician are giving thoughtful attention to your risk for heart disease. As you probably know, your LDL and HDL numbers are not really ominous. I assume from the absence of any mention of high blood pressure, diabetes, or cigarette smoking that you do not have these other risk factors for heart disease. Thus, the real question is whether your family history of heart disease suggests a genetic tendency to atherosclerosis, despite your fairly reassuring risk factor profile.

I’d want to know if your father had risk factors that you do not and at what age his heart attack occurred. If he was younger than 55 and had no other risk factors, I would be more concerned about genetic tendencies toward heart disease than if he were elderly and a heavy smoker when he had his heart attack.

It’s certainly worth a good try to lower your LDL and raise your HDL with the lifestyle changes you mention. If your father’s history fits the more worrisome profile, I think a trial of statin therapy—any statin—is worth serious consideration.

— Thomas Lee, M.D. and Richard Lee, M.D.
Co-Editors in Chief, Harvard Heart Letter

Posted by: Dr.Health

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