<p>H just came home from his physical. His blood pressure was his usual 120/70. His HDL numbers were slightly high, he is close to ideal weight, doesn’t smoke, is age 71.5. His internist wants him to start taking a station because of new guidelines, to reduce his risk of heart attack or stroke under the new guidelines. He and I are very surprised as the doc has never even hinted about this before. Just wondering if others have been started on statins now due to these revised guidelines that seem to greatly expand the number of folks who “should” be taking statins from 30M to even more!</p>
<p>I’m skeptical of the new guidelines. My understanding is it doesn’t take into account family history, which I think is very important for heart/artery disease. (Correct me if I’m wrong.)</p>
<p>I’ve been on statins for years. Several kinds. Liver enzymes really need to be checked. Which reminds me to get new blood work because I had to halve my dosage last year because of an elevated count. I’m on them because high-ish cholesterol runs in my family - though there is little history of heart disease - and there is stroke and statins have been shown useful in preventing death from stroke. </p>
<p>Yes, from what I’ve read so far it doesn’t. H’s dad started having congestive heart failure and stroke only just before he died at 80+ (Having had high blood pressure and cholesterol for many, many years prior. His mom had renal failure. He has relatives still pretty healthy in their 90s and none seem to have heart problems. I guess because H is 71.5, yes due to age alone, he is at increased risk of some cardiovascular problem. Am just nervous at side effects he could get from the statins, including muscle pain or weakness. <sigh>. We are waiting for callback from the internist now. H and I want to know how urgent if is for him to start the meds now vs attempting any lifestyle changes. I think his age makes it unlikely he can lower his risk so he won’t have to take statin, sadly. </sigh></p>
<p>I believe his younger brother us on cholesterol meds, but he’s not as trim as H and has higher stress job and life situation. H said according to the calculator the doc used at the office, his risk is 17% and it has to be below 7.5% for him not to need statins, under these new guidelines. </p>
<p>I have pretty high cholesterol, ( genetic) and my Dr has been after me for years to take medication, but I am not a fan of the side effects, so I refuse.
I already have fibromyalgia, so more muscle pain is not something I want to think about.
I take niacin & aspirin every week, and have cardio tests, ( which are fine) but have enough trouble dealing with how I feel now, without taking something that is supposed to be a preventative.
I have heart disease in my family, but I exercise a lot more than either my mom or grandmother ( who died from cardiac related- at 75 & 85, Im 56) & since my knee replacement a year ago, I am still working hard to get fitter.</p>
<p>Like Lergmom, I’ve been on statins for years. My mother had a silent heart attack in her mid 50s, and my oldest brother had a stent put in, in his late 50s, so yea, there’s a strong family history of heart disease. My mom eventually died of congestive heart failure at 82. I initially started at a low dosage and had to increase it after a few years; I finally got serious about my health (I guess it’s all relative), made some changes, and eventually was able to lower the dose back to my initial dosage and have been fine. My internist is actually board certified in clinical lipidology, so I trust his expertise. We actually had a very long talk about this a couple of weeks ago when I went in for my annual exam, and because I’m now about that age that my mother was when she had her heart attack, he knows how cautious I am. But my internist is a concierge physician, and he takes a lot of time to discuss almost anything I want to talk about, or ask him about… much more time than the majority of primary care physicians. </p>
<p>I’ve never had any muscle pain or elevated liver enzymes. I would disagree that your husband’s age makes it unlikely that he can lower his risk, unless you’re saying behaviorally he is not personally willing to make some changes… that’s he’s too set in his ways (but that’s a whole 'nother conversation). </p>
<p>Himom: HDL is good cholesterol and a higher number is preferable to lower. LDL is bad cholesterol–is that the number where your H had increased levels? The ratio of triglycerides to HDL is now considered more predictive of heart attack risk than total cholesterol or bad cholesterol. Does your H know his triglyceride numbers? Post your question on the Diet/Exercise thread–one of the posters there (Interested Dad) is quite knowledgeable on this topic.</p>
<p>The new one is controversial in that it significantly increases the number of adults to be recommended to use statin drugs, where there is already some controversy about their utility in people who have not already had heart disease.</p>
<p>Playing with the downloadable spreadsheet calculator for the new guidelines, it is rather difficult for a 71 year old male to get the calculator to report a 10 year risk of 7.5% or less. Example: [male, 71, African American*, TC = 150, HDL = 75, systolic BP = 109, HBP treatment = no, diabetes = no, smoker = no] gives a 10 year risk of 7.5%.</p>
<p>*The calculator considers African Americans lower risk than all others for the same other values.</p>
<p>There has never been a study that showed improved life expectancy from taking statins for men under 65 who haven’t had a heart attack or for men over over 65, regardless of whether or not they’ve had a heart attack, or for women of any age and any circumstance. Some studies have shown slight decreases in major/fatal coronaries, but these are offset by higher risk of dying of something else. For example, women on statins have statistically higher rates of diabetes.</p>
<p>There are circumstances that would make me consider filling a statin prescription (sky high LDL particle counts that don’t respond to diet/lifestyle), but I would treat a casual recommendation to start taking a statin based on a simple cholesterol test and/or those recent guidelines with a great deal of skepticism. As ucbalumnus points out, it’s virtually impossible for a 71 year old male to not be sold a statin based on those guidelines. That’s absurd. There’s no science to back up the health benefits of everyone taking statins.</p>
<p>The first place I’d look is the Triglyceride to HDL ratio. Above 3:1 is when you start worrying about risk of coronary artery disease (and all the other diseases associated with metabolic syndrome). And, before filling a statin prescription, I’d insist on a NMR LIpoProfile test to get an LDL particle count. Most likely, your hubby’s doc has no earthly idea about this stuff. For lots of reasons, the whole cholesterol test thinking is about 20 years behind the science. People with very low LDL cholesterol can be at extreme risk and people with moderately high LDL cholesterol can be at extremely low risk.</p>
<p>This is not to say that your hubby doesn’t have some risk factor that would warrant serious consideration of a statin. I would just say that it’s an area of medicine where you’ve got to grab the bull by the horns, do your own research, and take control of your own health care decision making. The doctor has to hand you the prescription in many cases. You have the right to thank him for it and toss it in the trash on the way to the car…</p>
<p>Two guys who do a good job of explaining a lot of this stuff are Dr. Thomas Dayspring and Peter Attila:</p>
<p>OK, H’s stats are:
age–71.5
race–not white, not African American
gender–male
total cholesterol–187
triglycerides–124
HDL cholesterol 47
LDL Cholesterol 115
non-HLD cholesterol 140
Systolic BP ranges between 120 to 100 (as 120 today at MD office)
Risk per calculator of having ASCVD over the next 10 years is about 17-18%, hence the statins.</p>
<p>Under all the scenarios I tried, given his age, only by changing his gender (and lowered his systolic blood pressure to 100–which he does sometimes read) could we bring his risk significantly lower to 7.5%, even if we optimized all the other numbers. It doesn’t consider waist size, hereditary, or other factors. Note: For a 72 year old female, being AA slightly increases your risk for ASCVD under the spreadsheet.</p>
<p>Since I’m a female and have low systolic BP, my risk is about 1.3 to 1.6%; optimal for my age is 1.7% (I’m many years younger than H). Looks like if my BP stays low, I finally have a 7.6% risk at age 74 (if all other numbers remain as they are today), until the guidelines change again and the figure out how to factor in more hereditary factors. My folks are still going strong in their 80s; neither are on any meds. My dad’s older sister is on a slew of meds and sees docs much more often than both my folks put together (they go annually).</p>
<p>I’m not a doctor. I wouldn’t presume to tell your husband what to do. He’s got to do his own research. But, if I had those numbers at that age, I would not even consider filling the statin prescription, without getting a particle count test. Frankly, I’d be surprised at the doc even prescribing a statin as the first step.</p>
<p>I would be mostly concerned with bringing down the triglycerides and increasing the HDL a bit. They are not horrible, but not great. They suggest at least mild insulin resistance. The blood pressure is excellent for someone his age and LDL cholesterol of 115 isn’t terrible. Under the old guidelines, I don’t think that would even call for a statin unless there were multiple risk factors in addition to age (an automatic risk factor). If it were me, I’d probably scale back sugar and grains to lower the triglycerides, which typically starts to happen quickly – in a couple of weeks. You’d really like to get the triglycerides under 100. Crank up the olive oil and start fish oil supplementation to raise the HDL.</p>
<p>I do not believe that his doctor can find a single study that shows improved health outcomes in a 71 year old male from taking statins. They can find studies that show statins lower lower LDL cholesterol, but that is NOT the same thing as improved health outcome.</p>
<p>The simple fact of the matter is that, when we hit 71 years old, the odds increase that something is going to kill us in the next 10 to 20 years…</p>
<p>The ironic thing is that he eats oatmeal regularly (like 4-5x/week). Maybe we will also start eating other grains–quiona, brown rice (instead of white, which he GREATLY prefers). Neither he nor I eat much sugar or even large quantities of red meat; he’s close to his ideal weight and has been his entire life. </p>
<p>The doc never mentioned any particle count test and seems to mostly be relying on the new guidelines and the handy-dandy new calculator that shows his elevated risk by virtue of his gender and increased age. He also has him on low dose 25mg synthroid for life, since his thyroid count was low.</p>
<p>Yes, I do understand that since he’s now older, there are increasing odds of something that may kill any of us and since heart & stroke risks are among the top causes of death, odds are pretty good that one of them may be the “cause of death” or something bad.</p>
<p>I know my younger brother was VERY upset about his blood work numbers and became an exercising fiend (literally doing the intense cardio workouts every day for 60 minutes and even going vegan for a few months). He did get his numbers in a range that he was satisfied with and has continued to be very vigilant about his diet and exercise. He says now in his mid-50s, he’s fitter than at any prior point in his life (complete with washboard abs). H is NOT going to go that route.</p>
<p>I just took a look at that risk calculator. At my current age (58), I get a risk of about 1%; if I change my age alone to 74, my risk goes to 15%. I think there’s a problem with the calculator, in that age, rather than health, is used to estimate risk of heart attack.</p>
<p>Don’t know if HImom’s husband will want to hear it, but cranking up the exercise is the typical way to raise HDL. Cranking up the exercise also helps fight the insulin resistance if that exists.</p>
<p>Living in Hawaii, they probably don’t need fish oil supplementation if they like to eat fish (not battered and fried). Replacing the white rice with something more fibrous may also help.</p>
<p>i can only speak for myself, but I would NEVER again go on a statin drug. I have permanent muscle and nerve damage from taking Pravastatin for only 18 months. Two other reasons I would not take statins are that they are known to increase your glucose level (which no one needs) and they remove most of the cholesterol from your body. Your body NEEDS some cholesterol, especially to protect cells and nerve endings. Along with a diet change try adding flaxseed, oatmeal, garlic, cinnamon (careful though as this is a blood thinner) and those psyllium husk drinks. Also add some anti inflammatory foods to your diet. </p>
<p>There is another more comprehensive test than the Berkeley, but I can’t remember it now. I also recommend “Diet Evolution” and the new book, “Fat Chance.” Both take a very scientific approach to diet and heart disease. </p>
<p>Thank you, interesteddad and ucbalumnus, for the information. I am wondering what VLDL cholesterol is? That number has been showing up on my lab tests. </p>
<p>I’ve found a great source of healthy recipes and nutrition information. I don’t think I can link to it, but the name is My New Roots and the extension is org, not com. Most of the recipes are vegetarian or vegan and many are gluten-free. Everything I’ve tried has been incredibly good. The recipes I use most often are The Best Lentil Salad, Four Corners Lentil Soup, Coconut Black Rice Breakfast Pudding, The Lifechanging Loaf of Bread (this may not be to everyone’s taste). I’ve learned to add chia seeds and hemp hearts to smoothies and oatmeal.</p>
<p>I’ve been taking Crestor for years with no side effects, as far as I can tell. Niacin, on the other hand, had very unpleasant side effects, and my understanding is that it’s no longer recommended anyway.</p>
<p>I recently started on statins. My particle counts are really bad. I would recommend that blood test too, it tells you a LOT. But yes, I have muscle pains and weakness. I’ve stopped lifting weights which is really, really unusual for me. I’ve been doing that for years and I just can’t get up the energy to do it. The other day my arm just started hurting for no reason. And it hurt all day. No reason and no relief. It had to have been the statin. I’m not terribly happy with that but I don’t want a heart attack either. My grandmother had two in her early 60’s - my doctor said “you are your grandmother.” He doesn’t want me to have a heart attack, either do I.</p>