Heart & Cardiology/cholesterol
Hi doc. Why are so many people on cholesterol meds for only slightly elevated cholesterol? I'm a 41 yo male that has had borderline cholesterol for years. My last lab was a bit high at 221, 124LDL and 48HDL. Thankfully my doc doesn't hand out meds like candy but when are people typically prescribed cholesterol meds? It seems to be all over the place.
Yes, it may seem like a lot of people are prescribed cholesterol lowering medications these days. I applaud you for being skeptical of just taking medications for the sake of taking medications because medications prescribed for the wrong indication or in the wrong context can have detrimental effects.
So, with that background, it is very important for physicians to identify the patients who would receive the greatest benefit from various medications. Recently, published in 2013, this was done for the treatment of blood cholesterol with “statins” – the most studied and widely used cholesterol lowering medication (http://www.ncbi.nlm.nih.gov/pubmed/24222016
). These recommendations are of the highest quality and derived from the most rigorous clinical studies available to date. The new recommendations suggest that physicians calculate a “risk score” for patients, rather than just treating a set cholesterol number. The use of a new calculator to estimate your 10-year atherosclerotic cardiovascular disease risk (risk of first nonfatal myocardial infarction, coronary heart disease death, nonfatal or fatal stroke) is available here:
. This new calculator more accurately identifies higher risk individuals for statin therapy, which focuses statin therapy on those most likely to benefit.
Based on the information you provided, your 10-year atherosclerotic cardiovascular disease (ASCVD) risk = 1.4% (I am assuming that you are white, no diabetes, no high blood pressure, and a non-smoker). If my assumptions are incorrect, then you can recalculate your score using the link above. A score of 1.4% is excellent, and you are not in a statin benefit group due to your 10-year ASCVD risk being <5% (although the guidelines state that <7.5% would be acceptable for the general population).
Many people have diabetes or high blood pressure or smoke – or a combination of one or more. With those conditions added to the risk calculator, a person’s 10-year ASCVD risk goes way up, most likely necessitating the need for a statin. That is mainly why so many people are on cholesterol lowering medications, because the general health of the world (especially the USA) is suboptimal. With regards to you, decisions about high blood cholesterol management should carefully consider and incorporate all of your particular characteristics and circumstances. Additionally, the benefits of a healthy diet, weight control, and regular exercise cannot be overemphasized.
Hope that was helpful,