Question: I read recently that if you are 65 or older, have 200 or higher total cholesterol, but have an HDL of 50 or higher, that taking statin drugs did not provide significant cardiovascular protection. Has this been confirmed by appropriately conducted scientific studies?
Dr. Hibberd's Answer:
There is no longer sufficient data to support this oversimplified statement. The old guidelines for diabetes used to tell us that one’s cholesterol/HDL ratio should be under 4.0. These guidelines have been revised down further and this ratio is no longer regarded as useful except perhaps in healthy non-diabetic populations with no cardiovascular risk factors.
Proper interpretation of cardiovascular risk lipid factors involve correlation of your LDL (bad cholesterol — the lower the better), HDL (good cholesterol — the higher the better), and triglycerides (ideal under 150 mg/dl).
Age 65 is not a determinant for treatment, but it certainly is a common presentation decade for coronary artery disease and heart attacks. Now, if one were 85, we would have some cause for debate.
Underlying diseases (such as diabetes, prior heart attack, hypertension etc. ), family history, and smoking are important to establish disease specific LDL target endpoints.
Cardiac patients are now advised to maintain LDL targets at least under 100 mg/dl with a preference to as low as 70 mg/dl for treatment.
These targets are much lower targets than otherwise risk-free populations with isolated elevations of lipids (cholesterol and triglycerides) where the LDL target is for less than 130 mg/dl, as high as 160 mg/dl ( but probably best if under 100 mg/dl judging from recent trials).
Diabetic patients are advised to maintain LDL levels under 100 mg/dl and ideally target to 80 mg/dl or less.
HDL targets are very easy to remember. For every percentage increase in HDL, there is a reported 2 percent to 3 percent reduction in cardiovascular risk. The higher the better, ideally over 60 mg/dl. Some patients are able to maintain HDL readings of over 90-100 mg/dl, in large part due to good genetics.