You went to the doctor this week. You gave blood, and your lipid panel shows that your cholesterol levels are off. Your doctor recommends lifestyle change and a lipid-lowering drug, a statin. You are neither sure that you can change your lifestyle around drastically enough to make a great impact on your cholesterol level, nor are you ready to start a new medicine on top the many others you are probably already taking (let alone the fear of side effects).

What is the best choice?

The best answer to this question would be “FOLLOW DOCTOR’S RECOMMENDATION“. However, the era of paternalistic medicine where doctors were “gods” is long gone. You have your word to say. Here is one way to think about it.

How high is your cholesterol level? Can lifestyle change alone bring it back down within the normal range? To put it simple, remember that overall lifestyle change can decrease your total cholesterol, LDL and triglyceride levels by up to 20% and increase HDL level by up to 10%. For instance, say your LDL (bad cholesterol) level is 115 mg/dL (Normal < 100 mg/dL), an optimal 20% decrease with lifestyle change alone can bring it down below 100 mg/dL. This is a pretty achievable goal if you are willing to put in the work.

However, there are other factors to consider. Do you have diabetes? Do you have hypertension? Do you smoke? Generally, your doctor will calculate what is known as ASCVD risk (Atherosclerotic Cardiovascular Disease risk) before deciding whether to prescribe a cholesterol-lowering agent or recommend lifestyle change alone. The ACC/AHA Pooled Cohort Equations take into account various risk factors, including age, sex, race, total cholesterol, HDL cholesterol, blood pressure, diabetes status, and smoking history. The decision to initiate statin therapy is usually determined by the estimated risk of experiencing a major cardiovascular event, such as a heart attack or stroke, within a specific time frame (often 10 years). You can calculate your own ASCVD risk using this calculator.

Based on these risk assessments, the guidelines generally recommend statin therapy for individuals who fall into the following categories:

1. Individuals with Known ASCVD:
   • This includes people who have experienced a heart attack, stroke, transient ischemic attack (TIA), angina (chest pain), peripheral arterial disease (PAD), or have undergone revascularization procedures like angioplasty or stent placement.
2. Individuals with High ASCVD Risk:
   • This category includes individuals with multiple major risk factors (e.g., diabetes and multiple risk factors) and an estimated 10-year ASCVD risk of 10% or higher.
3. Individuals with Diabetes:
   • Individuals with diabetes who are between 40 to 75 years of age, with LDL levels of 70 to 189 mg/dL
4. Individuals with : with primary LDL levels of 190 mg/dL or greater

Now back to the question in title: SHOULD YOU ABSOLUTELY TAKE YOUR STATIN? If you fall in any of the categories mentioned above, the answer is YES. It’s also important to emphasize that statins are not a substitute for a healthy lifestyle but rather a complementary tool to improve your overall heart health.

Statins have been used by millions of people worldwide and have an excellent safety profile when taken as prescribed. Like all medications, they may have some side effects, but they are generally well-tolerated by most patients. Common side effects, such as muscle aches or liver enzyme elevations, are relatively rare and typically reversible upon discontinuation or dose adjustment.

In conclusion, if your healthcare provider recommends statins based on your risk factors and cholesterol levels, consider their advice seriously and work together to find the right treatment plan for you. Remember, cholesterol management is not just about taking medications; it’s also about making positive lifestyle changes, such as a heart-healthy diet, regular exercise, and avoiding smoking and excessive alcohol consumption.

Yours in good health

MDLINE HEALTH